Veterans Day is when America stops to thank those who have sacrificed to keep the country safe and free. This year, gratitude for their service includes a significant step to help keep them healthier.
Most former servicemen and women (and their families) get their health care at civilian facilities, where only rarely do health professionals ask patients if they or close relatives have a military background. But not only do veterans suffer from a of ailments like post-traumatic stress disorder and brain injury, many who were in combat zones may also have been exposed to hazards such as the defoliant in Vietnam, or huge in Iraq and Afghanistan that produced toxic fumes.
Recognizing the potential for missing important health issues, a small group of medical professionals banded together to ensure that in the future doctors will at least be aware of the possible medical problems of former military members, who now number about 14 million. Going forward, the exam every medical student and new physician must take to get a license will include questions about military medicine. That, in turn will force medical schools to teach it.
Brian Baird, a former Democratic member of Congress from Washington and a licensed clinical psychologist, has helped spearhead the change, which is being publicized as the country prepares for Veterans Day this Wednesday. He said he was inspired by some of his own patients who returned from duty in need of help.
鈥淲e don鈥檛 even ask, 鈥楬ave you or a loved one been deployed overseas,鈥欌 he said in an interview. 鈥淎nd I thought, what a terrible oversight.鈥
Baird set out to talk to every medical organization he could find. Several responded, or were working on a similar project at the same time, including the White House鈥檚 鈥溾 initiative.
Baird found an eager partner in Steven Haist, a physician and vice president at the , which develops and runs the .
Haist has spent nearly four years organizing the effort and bringing in specialists from the Department of Veterans Affairs and every branch of the military to develop and write the questions. Military medicine will be included in all three of the exam鈥檚 鈥渟teps,鈥 which students take at different points in medical school and after they complete the early phases of post-graduate training.
鈥淚n some respects, I think it could have been done a lot sooner,鈥 said Haist, given many of the well-recognized issues affecting returning troops from Vietnam and the first Gulf War. But he said he hopes that ensuring that physicians know about potential problems 鈥渨ill improve the health care that is received by returning deployed servicemen and women and their families.鈥
Dr. Karen Sanders, who helps oversee academic training for the VA, and who got the project funded, says she鈥檚 confident the change will make things happen. 鈥淚f you change the exams, schools and curricula will follow,鈥 she said. 鈥淲e hope this will drive schools to offer courses鈥 in medical conditions experienced by members of the military. A conducted by the Association of American Medical Colleges found that as of 2012, only about half the schools had such courses.
Other medical organizations have also acted to better integrate the health problems stemming from military duty into non-military health care. Both the and 聽are actively encouraging providers to ask patients about their or a family member鈥檚 military service.
But encouraging is not enough, say Howard and Jean Somers. Their son, Daniel, in 2013 after being unable to receive treatment for mental health issues upon returning from Iraq. They have been working to improve the care at the VA and bring more attention to returning troops鈥 health problems ever since.
鈥淗ow do you make it a requirement without making it part of the licensing or re-licensing,鈥 said Howard Somers, a retired urologist.
They called putting questions on the licensing exam 鈥渇antastic,鈥 but stressed that something similar needs to be done to educate doctors who have completed their training and initial licensing.
In order to maintain his medical license, said聽Howard Somers, 鈥淚 had to take an online course in pain management. That would be another way to address this, to get medical societies to make this a requirement.鈥
Former Rep. Baird agrees. 鈥淚鈥檝e asked a lot of physicians about it, and many of them said, 鈥榊ou know I鈥檝e had courses in things I will never see in my practice. But there鈥檚 a pretty darn good chance I鈥檓 going to see somebody who鈥檚 been deployed.鈥欌
But getting military service training to be a required part of continuing education for doctors is a daunting task. 鈥淵ou鈥檇 have to deal (separately) with every state medical board,鈥 says the VA鈥檚 Sanders.
There is also a parallel effort to put questions about military service not just on intake forms that patients fill out but also in the electronic medical records that are filled in by health care providers.
Erika Koch, a spokeswoman for , the dominant software developer in the market, said that the company鈥檚 standard record does include questions about military service, but they don鈥檛 show up unless the customer聽 — a hospital or doctor鈥檚 office 鈥 requests that. 聽鈥淧ediatrics, for example, will not turn it on,鈥 she said.
But Baird insists that the question should be included on every single electronic medical record, including those for children: 鈥淭he classic case would be a child struggling in school, who can鈥檛 sleep.鈥 A doctor might prescribe medication, he said, 鈥渂ut never stops to ask if anybody in the (child鈥檚) family has been deployed.鈥
Baird recognizes that while the adoption of the test questions marks a milestone, there is still a long way to go. 鈥淢y goal is nothing less than making this a permanent聽 aspect of our medical education and our health care system,鈥 he said. 鈥淚t鈥檚 rather shocking that it hasn鈥檛 been done actually.鈥