The Department of Veterans Affairs (VA) oversees the nation's largest integrated health care system, providing care to 9 million veterans at more than 1,000 locations.1 One of the four statutory missions of the VA is the education and training of clinicians to enhance the quality of care provided to veterans. The nation's academic institutions and the VA have a long-standing, close relationship, and the VA has the largest training program for health care professionals in the United States. In 2018, about 120,800 trainees in more than 40 disciplines received some or all of their clinical training in the VA2; however, many of these trainees are not familiar with aspects of military service that affect health and wellness. Also, many clinicians outside of the VA or military are unaware of the importance of specific aspects of the military health history. In one study, more than one-half of family physicians reported never or rarely asking about military service and rated their knowledge as inadequate, but 60% believed knowing veteran status was important to provide better care.3 In another study, internal medicine residents rotating in VA medical centers scored low on knowledge of military sexual trauma and posttraumatic stress disorder.4
The clinical expertise of health care professionals in the VA and military health systems can be leveraged to expand training opportunities on topics related to veterans' health.5 For nearly two decades, the VA has provided a cheat sheet for trainees and other clinicians to use when taking a military health history. The questions clarify veterans' medical problems and concerns; the answers can help establish rapport and therapeutic partnerships with veterans and their families. Answers may also provide a basis for timely referral to specialized medical resources. This cheat sheet has evolved into the Military Health History Pocket Card, developed by the VA Office of Academic Affiliations in 2001. The card is updated every two years. To develop the questions, the Office of Academic Affiliations communicates with content experts in 14 federal offices, requesting updates to the card. The offices include Mental Health and Suicide Prevention, Post Deployment Health Services, Patient Care Services, Women's Health, Rehabilitation and Prosthetics Services, and Public Health and Environmental Concerns.
The pocket card includes many of the major items addressed in Yedlinsky's article in this issue of American Family Physician,6 including military conflict eras with unique health risks; environmental and exposure concerns; immunizations; infectious diseases; and sample questions to address mental health, sexual trauma, post-traumatic stress, and other information that is unique to military service members and veterans. The pocket card can give clinicians a better understanding of the veteran's perspective; encourage more careful, veteran-centered histories; and stimulate case discussions augmented by information found on the Office of Academic Affiliations website (https://www.va.gov/oaa/). The pocket card should be considered for educational use during daily work rounds or informal case-based conferences.7
The pocket cards are printed and disseminated to VA medical facilities each July in time for the arrival of new trainees. Cards can be requested through the Office of Academic Affiliations Data Management Center and are available at https://www.va.gov/OAA/archive/Military-Health-History-Card-for-print.pdf. Additional resources for obtaining a military health history are provided in Table 1.
|National Center for Posttraumatic Stress Disorder|
|Office of Academic Affiliations|
|Public Health: diagnosis and treatment of exposure health effects|
|Public Health: postdeployment health services|
|Veterans Health Initiative: independent study courses|
|War Related Illness and Injury Study Center|
|Women Veterans Health Care|
The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the U.S. Veterans Administration or the U.S. government.