In a panel discussion from ACOFP ’23, military physicians talk about what civilian physicians need to know about caring for our servicemembers and veterans.
Adapted from a session featuring Col. Brandon Isaacs, DO, US Air Force National Guard; Col. Natalie Nevins, DO, MSHPE, US Army Reserve; Captain Joel Feder, DO, FAOCFP, US Navy Ret.
How can you identify which patients in your practice have a relationship to the military? The only way to know is to ask, and it’s important to ask as part of your normal history: “Have you ever served, are you currently serving, or are you a family member of someone who is serving or has served?” Asking about military affiliation opens up a new level of information about your patients and their needs, allowing you to make better medical decisions.
Military members are often proud of their service, but relatively private about it. Yet their experience has a profound impact on them and their healthcare. For those who are currently serving, the diagnoses and treatment they receive have the potential to impact their career. Ex-military members have a tendency to hide their weaknesses, and may not know about or may be reluctant to use the benefits available to them.
Military members may be currently serving or they may be veterans, and they may be active duty or part of the reserve or the National Guard. Reservists and the National Guard, in our most recent wars, have been deployed more than those on active duty, and for anyone of the military, deployment is when, not if. If you have patients coming back from deployment, ask the harder questions about how they are really doing and how they are reintegrating back with their family. While people are deployed, their families are often suffering in silence, so ask families how they are doing as well.
To support veterans, familiarize yourself with Veteran Service Affairs resources and VA benefits. Some veterans have had bad experiences with the VA and may be reluctant to use these services. They may now have diseases that are related to their past service, for instance, Vietnam vets with exposure to Agent Orange. Listen to them and encourage them to try again. Make copies of VA resources and keep them in your waiting room so that veterans who may not want to disclose their veteran status also know that they exist. In particular, any veteran who has suicidal ideation can walk into any ER and get help and have it be covered.
When it comes to payment for treatment, the most important piece to know is whether the patient’s injury or health condition is related to service. You may need to coordinate with their military healthcare providers to know what is covered. Civilian health insurance may not approve things that flight medicine requires.
Current servicemembers are expected to be physically and mentally ready for deployment at all times. They may avoid seeking treatment for fear that it will jeopardize their ability to do their job. If you are a civilian physician seeing a servicemember, communicate with the surgeon for their unit so you can help protect that individual.
Military members often want to know if a medical issue will cause them to lose their job. Answer, “I don’t know, but I can tell you what the medical prognosis is and you can take that back to your military providers.” Their unit depends on them doing their job at peak performance and safely. Military medical providers fight very hard to keep people on the job, and to get them the care that they need. Combat is not the only thing that can kill a service member. They can also die from heart disease, diabetes, and other conditions that aren’t treated properly because they’re working hard and don’t take time to see the physician.
Your treatment may impact a person’s career. Certain diagnoses or medications may trigger a Medical Evaluation Board, which investigates whether the issue is “waiverable,” or whether it is cause for dismissal from the armed forces. There are certain diagnoses that bar someone from continued military service, even if the diagnosis is only under consideration. Even things like a CPAP can be a problem, because a CPAP machine can’t be plugged in in the middle of Afghanistan. As soon as someone is on diabetic medication, they’re nondeployable, and as soon as someone is on insulin, they’re out of the military. For those reasons, try lifestyle modifications before medications.
Osteopathic manipulation can be powerful tool to help military members. The use of some medications, even ibuprofen, can ground some people from doing their duties. Osteopathic manipulation can allow them to receive treatment for health conditions while maintaining flight status. Dr. Nevins said, “You give them meds, you take them out of the seat; you give them OMT, you put them back in the seat.” Most soldiers have some kind of musculoskeletal pain. Treat them, and you will be doing the military a huge service. For military members, OMT is a skill set that is not replaceable.
This information was presented at the ACOFP 60th Annual Convention and Scientific Seminars. We are pleased to offer more than 40 hours of AOA Category 1-A CME and (new this year!) AMA PRA Category 1 Credit(s)™ to watch on-demand from the convenience of your home or office! Learn more: https://www.acofp.org/acofp23