In aviation, the right seat is usually designated for the instructor. In the field of medicine, it encompasses the roles of the diagnostician, mentor, and gatekeeper. I once piloted a T-37B “Tweet” trainer from the right seat, not as a learner, but as an individual entrusted to provide guidance. That experience influenced my approach to clinical decision-making, interdisciplinary fluency, and orchestrating care.
During a military training exercise, our squad confronted a simulated challenge: an electrified “bridge” spanning a deep “gorge.” The objective was to cross safely and prevent the “enemy” from gaining access. Time was of the essence. That’s when I inquired of the referee, “How deep is the gorge?”
“Very deep,” he responded.
“Knock one side of the pole off the bar and let it drop!” I called out.
We discarded the poles, untied the rope, and raced against the clock. The referee smiled: “The decision to dump the poles was ingenious.” I wasn’t the strongest or speediest, but on that day, I gained respect, not due to physical strength, but for asking the right question at the right moment.
**Team clinics: proximity isn’t partnership**
In medicine, not every gathering is a team.
– Multidisciplinary clinics often assemble clinicians in one area, yet each interacts with the patient separately. There’s no unified plan, no integration, merely parallel paths. The whole is frequently less than the sum of its constituents.
– Interdisciplinary teams take it a step further. Each clinician examines the patient, and then the team convenes to discuss findings. In my own practice, I employed various colored pens to annotate DSM-IV and DSM-5 criteria, with each color representing a contributor to the final diagnosis. The outcome was a chart of criteria met or not met, with clear attribution. The collective became greater than the sum of its components.
– Transdisciplinary teams, particularly in early childhood contexts, elevate integration to a higher level. I would participate in sessions with other team members, observing and providing support. One clinician (often the one the child was drawn to) would steer the interaction, completing tasks assigned by others. To my astonishment, one toddler perceived me as “dad-like” and sought engagement. I adapted, embraced the unfamiliar role, and performed excellently, as noted in the team’s post-session review.
That experience proved valuable. I mastered delivering the ADOS-2 like a skilled psychologist. I could administer the STAT-MD with ease. These transdisciplinary abilities were not merely theoretical; they shortened waitlists for autism evaluations and provided evidence-based care to families who had endured prolonged waits.
**Color-coded diagnosis: operational clarity in autism evaluation**
In both aviation and autism diagnosis, clarity is indispensable; it’s integral to operations. Throughout my years giving second opinions in Illinois and at Madigan Army Medical Center, I became the reliable arbitrator. Families, clinicians, and institutions approached me not for comfort, but for resolution.
To assure transparency and accuracy, I crafted a color-coded annotation system for DSM-IV and DSM-5 criteria. Each color designated a different contributor (psychologist, speech-language pathologist, occupational therapist, parent or teacher or myself). In my diagnostic tables, criteria were labeled as met or unmet, with proper attribution. The result wasn’t merely a diagnosis; it was a record of clinical reasoning.
This framework enabled me to weave interdisciplinary input into a cohesive operational narrative. It elucidated who contributed what, where consensus formed, and where differences necessitated adjudication. It proved especially powerful in interdisciplinary teams, where findings required synthesis, not just independent reporting.
These transdisciplinary abilities served me well. I learned to execute the ADOS-2 like a practicing psychologist. I could conduct the STAT-MD effortlessly. And because I was capable of both, I reduced waitlists for autism evaluations. That’s not simply efficiency. That’s equity.
**The Tweet and the transfer of control**
At Randolph AFB, I piloted the T-37B “Tweet” (a 6,000-pound dog whistle manufactured by Cessna in 1959). It was the ideal system for converting JP-4 jet fuel into hearing-damaging noise. My pilot was an experienced instructor. As we secured ourselves, he cautioned: “If I say ‘Bailout, Bailout, BAILOUT!’ eject without hesitation. By the third call, you are the aircraft commander. I’ve already exited.”
At elevation, he turned to me: “Your controls.”
I adjusted the stick to confirm. Then I commenced flying:
– Aileron roll, completing a full 360° spin around the longitudinal axis.
– Barrel roll, a spiral loop-and-roll combination.
– Loop, vertical rise, over the peak, returning to heading. I hit the artificial horizon mark flawlessly.
I experienced enough G-forces to feel lightheaded. Thus, we bypassed the parabolic arc (the “Vomit Comet” maneuver). I executed