JFWW - Taking a Military Health History

  Supplementary Q&A by Dr. Jeff Brown
Q: How might you go about getting community providers to start taking military histories?
A: The first initiative has to be one of education through CME. For group and institutional settings, adding military health history questions to electronic health records would go a long way toward increasing awareness and participation.
Q: What efforts are currently be made to increase the likelihood of taking a military history by civilian providers?
A: The AAMC, AAN, Joining Forces, and others have started initiatives to get the word out and to have military health history and veterans cultural awareness added to medical school and nursing school curriculum. We are also encouraging the VA's Office of Academic Affiliations to REQUIRE training for all medical personnel who rotate through their facilities (70 percent of US medical school graduates.)
Q: Like in the video Dr. Klapholtz showed, a person might not look like a stereotypical service member or veteran and what can a provider look for?
A: The message we were trying to convey is that there is usually no difference in a veteran's appearance from other medical patients: young, old, middle age, male, female, and from varied social, cultural, and economic backgrounds. The only way to identify veterans is to ask EVERY patient if they or someone close to them served in the military.
Q: Are there ways to tell the difference between PTSD and normal re-adjustment from returning from war?
A: Many veterans will have post-traumatic stress symptoms - (hypervigilance, flashbacks, anxiety, depression, sleep problems, etc.) as part of the "normal" reintegration process. These symptoms become a "disorder when they are of a frequency and severity that they disorder the patient's life. i.e. interfere with functioning on a regular basis.
Q: With regard to reintegration challenges, have these challenges changed from those experienced in previous conflicts and is our response today better than those in previous years?
A: The symptoms from recent conflicts are similar to those from earlier conflicts. But beginning in Vietnam, combatants faced additional stresses because it was difficult to tell the enemy from friendly civilians. This increases the likelihood of errors in judgment, killing enemy and friendlies face to face, and applying retrospective morality (what seemed appropriate in a wartime setting may be questioned after return to civilian life.)