COMMUNITY MEDICINE: THE WEAK LINK IN VETERANS' HEALTHCARE
“Most community physicians do not identify which of their patients have served in the military.
..... The consequences can be catastrophic.”
Background: Ten percent of adults (including 16 percent of adult males) have served in the U.S. military. Eighty percent of them currently receive most of their healthcare from non-VA civilian doctors. But – civilian doctors rarely identify which of their patients are veterans.
Following the presentation, participants should be able to answer the following questions:
- How do I identify which of my patients have served in the military and why is this important?
- Why should providers of all specialties including obstetrics and pediatrics identify patients who are veterans?
- What questions should I ask, how should I ask them, and which should be avoided?
- How does past military service affect my patient's past, present, and social history?
- What psychological and medical conditions in this population are most often misdiagnosed in a community setting?
Is there a simple way to help eligible veterans receive VA services?
Presentation: The speaker has prepared a 50 minute presentation suitable for Grand Rounds, student lecture, and resident conferences. Veterans’ culture and common medical and psychological sequelae associated with military service are discussed. These include early and late-onset PTSD, Traumatic Brain Injury, infectious diseases, and toxic exposures. There are also short sections on “moral injury” and psychological trauma suffered by military medical personnel. This presentation draws on the speaker’s personal medical-combat experience, current literature, and video footage of military encounters.
GULF WAR SYNDROME, TRAUMATIC BRAIN INJURY, PTSD, AGENT ORANGE TOXICITY:
HOW TO TAKE A MILITARY HEALTH HISTORY
Background: Physicians are often hesitant to ask patients about past military service because they don't know which questions to ask, why to ask them, and whether the veteran-patient might be offended by them.
After attending this presentation, participants should have achieved the following goals:
- Understand why it is necessary identify community patients who have served in the military.
- Learn how military service might affect a patient's medical and psychological care and treatment.
- Learn which questions are most likely to yield pertinent history and which should be avoided.
- Have a general understanding of veterans benefits and referral services.
PTSD AND MORAL INJURY: EFFECTS ON MILITARY VETERANS
Background: PTSD and Moral Injury have become the signature psychological conditions of recent wars. While PTSD is commonly associated with physically traumatic events, Moral Injury occurs when there is a breach in deeply held beliefs that relate to right and wrong. It is sometimes described as "Injury to a person's soul." At the most simple level, teaching soldiers to kill requires a redefining of traditional morality - that may no longer seem relevant when actions are looked at retrospectively. At the extreme level, when a patient believes that he "can no longer live with himself" because of visceral guilt, he is at risk for self-harm. Many of the teaching points are pertinent for patients who never served in the military.
The speaker will discuss the difference between moral injury and "everyday" guilt, the role that moral injury can play in PTSD, which individuals are most vulnerable, how modern warfare has changed to create moral injury, and what types of treatment modalities are available. Psychological strategies seem to run parallel to faith-based strategies, but they might both be useful for specific patients. Patient examples and personal experiences are presented for learning purposes.
ABOUT THE SPEAKER
Dr. Jeffrey Brown is a retired community physician who teaches as a Clinical Professor at New York Medical College and at Weill Cornell Medical College. He is the author of “The Unasked Question,” a landmark JAMA essay on this topic, along with four books and numerous professional papers. He is a member of the AAMC’s Military History Initiative, and he served in Vietnam as a decorated front line infantry battalion surgeon.