National Guard, Reserve families depend on family physicians
WEB EXTRA! FPs have
resources to help troops and families The war in Iraq is sending many of America's family physicians into new medical territory. Their patients -- carpenters and plumbers, teachers and clergy, truck drivers and homemakers -- are leaving Main Street, U.S.A., and shipping out for active military service. To serve them and their loved ones well, family physicians are trying to bring themselves up to speed on military medicine.
"As a community provider, I don't have the same training as military physicians," said Lisa Corum, M.D., of Fort Mill, S.C., the new physician member of the AAFP Board of Directors. "The National Guard and Reservists are people in the community. They're not associated with a military base, so they're in the same situation as the military families, but they don't have the same support."
Among the supports not immediately available to these National Guard and Reserve families: commissaries that soften the financial blow of reduced income when a soldier moves from private sector to military pay; on-site counseling to cope with the stress of sudden single parenthood; legal aid services for such issues as power of attorney for spouses; and guaranteed access to medical care through on-base facilities.
As of April 21, the Department of Defense said 171,917 members of the National Guard and Reserve were on active duty.
On guard for symptoms
Many National Guard and Reserve families must go it alone as they face the socioeconomic, emotional and psychological challenges of preparing for deployment. Stress-related somatic ailments as well as anxiety, depression and other psychological symptoms crop up. And without support from their family physicians, many deployed families can decompensate, said Lt. Col. Lori Heim, M.D., of Southern Pines, S.C.
"For example, spikes in child and spouse abuse occur during the period before and after deployment," she said. "That's because this is a time when they are most afraid."
To prevent such incidents, watch for and address somatic symptoms - changes in sleep or appetite, stomach pain or headaches - throughout the deployment period, say military physicians. When signs of stress overload appear, physicians should inquire.
"I learned to ask about deployment whenever I see TriCare (the insurance for deployed Guards and Reservists and their families) or when I read in the record that the person is in the Guard or Reserve," said Viviana Bianchi-Martinez, M.D., of Davenport, Iowa. "Almost always, there's a relief that they are being asked and they can talk about it."
For tips and resources, see "FPs Have Resources to Help Troops and Families" at http://www.aafp.org/fpr/20040600/10.html.
Coming home again
When a soldier returns with an injury, the soldier's and family's medical and psychological health need attention. Military physicians often arrange for rehabilitation in distant Veterans Administration hospitals, but many soldiers may prefer to be treated at home to be close to family, said Bianchi-Martinez, who has made such arrangements for one of her patients. "He is undergoing rehab for a spinal cord injury," she said. "Once he was transferred to the U.S., I talked to the doctors at Walter Reed Hospital, then his case manager at the Milwaukee VA spine center. I called TriCare and organized for his care and rehab to be done at home instead of (his) having to go to Fort Campbell, Ky.
"We could do that because I made a few telephone calls. Never underestimate the power of a telephone call."
Many National Guard and Reserve families rely on family physicians to help them understand their loved one's injuries and the prognosis for recovery and rehabilitation, Bianchi-Martinez added.
Asked to name the most important contribution a physician could make to a soldier's well-being, one of Bianchi-Martinez's patients who had returned home from service responded, "For me to know that my wife has somebody who cares for her, somebody who cares for the kids. To know that they're in good hands helped immensely."
Ultimately, the greatest value is awareness, Bianchi-Martinez said. "We need to ask ourselves, 'Are we aware of these families? Are we aware of their pain, their sorrow and their pride in these soldiers?'"
To contact writer Leslie Champlin, e-mail lchampli@aafp.org.
FP Report is published by the
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Copyright © 2004 by
American Academy of Family Physicians.