President's Message

AAFP Resources Can Help Us Help Returning Vets

February 29, 2012 04:00 pm Glen Stream, M.D., M.B.I.

I don't know about you, but I've always had a lot of respect for our armed forces, and now that the war in Iraq is finally over and the war in Afghanistan is winding down, we as family physicians are in a unique position to help our U.S. troops when they get home.

[Glen R. Stream, M.D., FAAFP, MBI]

AAFP President Glen Stream, M.D., M.B.I.

More than 2 million U.S. soldiers served in either Afghanistan or Iraq -- or both -- during conflicts that started in 2001 and 2003, respectively. According to the White House, half of the veterans returning from those two wars will receive medical care in the private sector rather than from the U.S. Department of Veterans Affairs (VA). That private sector care largely will be provided by us.

In fact, a recent article (extract) in( JAMA: the Journal of the American Medical Association, noted that there are more than 22 million veterans in the United States; only 37 percent are enrolled in the VA health care system, while 56 percent have private health insurance, and 7 percent have no insurance.

These Americans have sacrificed much for our country, and now we are in a unique position to care for them and their families, but for some of us, that may prove difficult because we may be seeing injuries or disorders with which we have little experience.

According to the VA, about one-third of the veterans returning from Iraq or Afghanistan will experience signs or symptoms of combat stress, depression, post-traumatic stress disorder (PTSD), or traumatic brain injury (TBI). The Army Times reported in 2010 that there were 950 suicide attempts( each month by veterans who were receiving treatment from the VA. From 2005 to 2010, an average of one service member committed suicide every 36 hours, according to the VA.

Nearly half of the veterans treated by the VA after serving in Operation Enduring Freedom or Operation Iraqi Freedom were diagnosed with a mental health problem, and these issues are not affecting just the troops. More than 40 percent of active-duty service members have children.

Some of these medical problems fall into areas in which we might have little or no experience, but we still want to -- and need to -- be there for these veterans. That is why the AAFP is partnering with first lady Michelle Obama's Joining Forces campaign, which calls attention to the problems facing veterans and offers support and resources to military families.

Shortly before the launch of the initiative last April, (then) AAFP Board Chair Lori Heim, M.D., of Vass, N.C., said during a meeting at the White House that the AAFP would support such a campaign, but physicians and other health care professionals often don't know what to screen for in military patients or what to do when a problem is identified.

In response, the AAFP has created a Web page to help members help this important group of patients. Resources offered by the Academy include

  • a screening tool for PTSD;
  • an American Family Physician article about caring for returning veterans;
  • a link to a free, one-hour AAFP-approved CME course designed to help primary care physicians diagnose, treat or refer postdeployment mental health issues in military services members; and
  • patient information about PTSD and TBI from

I often have found it challenging to get my patients -- military or otherwise -- to open up and discuss issues such as those identified above. And I'm not always certain how to proceed when they do, so I look forward to using and learning from these AAFP resources to help me take better care of the veterans in my practice.

Any of you who have an interest in caring for military members and their families also may contact the Citizen Soldier Support Program(, which connects service members and their families to primary care and behavioral health professionals who are trained to address issues that affect military members and their loved ones.

They've done their duty. Now let's do ours.