Guest Editorial

Service Members Deserve High Quality of Care FPs Can Provide

September 10, 2014 03:43 pm Capt.Maureen Padden, M.D., M.P.H.

After 10 years of war, the United States is drawing down its military forces. In fact, the Pentagon has announced plans to reduce the size of the Army to roughly 450,000 soldiers, which would be the smallest U.S. Army force since before the United States entered World War II. The Air Force, Marines and Navy all will see modest reductions.

[Capt. Maureen Padden, M.D., M.P.H.]

Capt. Maureen Padden, M.D., M.P.H.

These changes mean service members will be returning home to their communities, where family physicians could find themselves providing primary care to a population they may not have interacted with in the past. Will family physicians be ready?

I recently represented the AAFP at a Joining Forces meeting at the White House. This meeting, sponsored by the first lady and her staff, focused on discussing the mental health needs of service members, veterans and their families. Attendees included health care professionals from the Department of Veterans Affairs (VA), Department of Defense (DoD) and other medical professional organizations; representatives of health plans; and other stakeholders. As an experienced military family physician, it was a distinct privilege to be included in a discussion focused on improving health care for veterans.

There was a time when mental health care for veterans was not adequately discussed or prioritized. Like our modern military, veterans from previous wars and conflicts also were exposed to conditions that caused health disorders such as post-traumatic stress disorder, but civilian physicians and the military did not always recognize or identify them. But with advances in medicine and a recent culture change among military leadership, awareness of mental health concerns for veterans has increased. Today, we are a different military with a more informed health care system and a nation committed to caring for our veterans.

Serving in the Armed Forces is a unique experience. Soldiers, airmen, sailors and Marines are a proud collection of our nation's finest. At one time in the military, being diagnosed with a mental health disorder could have been perceived as a sign of weakness or an unwillingness to fight. Service members were reluctant to seek treatment or discuss their concerns with leaders for fear of being labeled. Fortunately, the culture has changed. Service members now are encouraged to seek treatment if they think they have emotional, mental or physical concerns. Leadership throughout the military has been educated to identify signs of mental or emotional strain among their forces, and all service members are thoroughly screened after a deployment by a health care professional to detect signs of mental health issues.

Although these cultural changes are substantial, there is still more work to be done.

As service members retire or simply go home after their period of service, they will return to their communities, where family physicians and other primary care professionals will be called on to ensure they receive high-quality and culturally competent care. Health care professionals from both the military and civilian communities will need to work together to ensure our service members receive this care.

The patient-centered medical home (PCMH) model is uniquely suited to addressing the mental health needs of veterans, service members and their families. And we family physicians are perfectly positioned to offer that care, given our role in caring for patients throughout all stages of their lives.

Family physicians should familiarize themselves with local outreach programs veterans can utilize for additional support. If you are fortunate enough to have a VA facility near you, staff there are often able to provide you and your staff with information about local resources. Although some of these programs may require a health care plan, many of them are free and can provide veterans with additional support.

In addition, family physicians practicing in medical homes are beginning to embed behavioral resources into their PCMHs to specifically address mental health needs. Doing so often hastens veterans' readiness to seek help by removing the fear and barriers they may feel regarding seeking mental health care. PCMHs that are so equipped should embrace management of mental health issues and provide treatment options within the context of the multidisciplinary team that knows these patients best instead of routinely referring them to a specialist at another facility. By embedding mental health specialists within the medical home, we can help eliminate patients' fear of losing privacy or being labeled.

Family physicians who have limited interaction with the expanding veteran population may wish to acquire more information about the unique health care challenges many veterans face. Organizations such as Blue Cross and Blue Shield of North Carolina have already enacted training within their pay-for-performance programs to address topics associated with culturally competent health care for veterans.

The AAFP will be offering two national courses in 2015 that include sessions on post-traumatic stress disorder:

  • The Emergency and Urgent Care live course will be offered April 16-19 in Las Vegas and Nov. 4-7 in Bonita Springs, Fla.
  • The Family Medicine Update live course is scheduled for June 23-27 in Denver.

Other educational options are worth considering, as well. Perhaps, for example, the American Board of Family Medicine could consider developing a self-assessment module to address the unique health care concerns of the veteran population.

Individual family physicians can lead in this area by contributing related educational content to American Family Physician. Physicians who present educational topics at the AAFP Assembly, national courses and chapter meetings also can include veterans as a specific patient population when relevant.

Caring for this population will require us to identify them as they present for care. We ask patients about their pain and how they prefer to learn, but how many nonmilitary physicians ask their patients if they (or a family member) have served in the military? Asking this question and noting military service in the medical record is a good first step toward recognizing and treating the unique needs of this special population.

The men and women who serve our country today comprise the most intelligent and highly trained military our country has ever seen. Young service members of today communicate differently than they did 10 years ago. They rely on social media and instant communication using e-mails, texts, tweets and the Internet.

Today's veterans also represent an all-volunteer force. They felt a higher calling to serve our nation, much like many of us felt a higher calling to serve as physicians. Our service members deserve the highest quality of care we can provide them. There is no one better suited to care for America's warriors than family physicians, but we must be ready to meet their unique needs as we enter this next phase of our nation's history.

Capt. Maureen Padden, M.D., M.P.H.,(www.med.navy.mil) is the commanding officer of Naval Hospital Pensacola in Pensacola, Fla. The views presented in this article are those of the author and do not necessarily represent the views of DoD or its components.

Additional Resources
Veterans Crisis Line(veteranscrisisline.net)

Connect veterans with local resources(maketheconnection.net)


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