Is there a military veteran on your patient roster? Here’s what you need to know

You may not realize that the patient in front of you once served in the Canadian Armed Forces and experienced combat first-hand. Or maybe it’s your patient’s spouse or parent who is the military veteran. Researchers and clinicians working in the field of veteran health say physicians should make it part of standard practice to inquire about their patients’ personal or family history of military service. This is important, they say, because the challenges associated with serving in the military often have a direct and significant on a patient’s health. “When a former soldier comes to the office, they will come with a 2,000-page medical file from serving everywhere and most primary care providers just find it difficult to manage these patients,” said Dr. Ramesh Zacharias, a chronic pain specialist and CEO of the Chronic Pain Centre of Excellence for Canadian Veterans, a research institute in Hamilton, Ont. Chronic pain and mental health challenges are more prevalent among military veterans than among the general population. Dr. Zacharias cited statistics from a 2016 study that looked at life after military service: 40% of male veterans suffered from chronic pain, compared to 20% among the general population. Among female veterans, 50% suffered from chronic pain. “So male veterans were twice as likely (than the general population) to end up with chronic pain at the time they were released,” said Dr. Zacharias. “And one in two females who enlist in the military is likely going to eventually be suffering from chronic pain.” Physicians treating veteran patients for chronic pain should not overlook potential mental health issues. An estimated 65% of veterans with chronic pain also suffer some form of mental illness—a proportion that’s much higher than among civilians with chronic pain, said Dr. Zacharias. “Sadly, because of their service they not only experience physical injuries but they also experience mental challenges,” he said. “It’s unusual to see a veteran who only has chronic pain. The majority of them also have sleep issues, mood issues and PTSD.” A big challenge for doctors is that many veterans have this engrained mentality that seeking medical help is a sign of weakness. Some may also resist proposed interventions such as meditation or yoga. Read: The concept of ‘normal’ and emotional plaque Another challenge for doctors? Some veterans may not voluntarily disclose their military past. This is why it’s critical to ask about a history of military service, especially when a patient is seeking help for mental health issues, said Dr. J. Don Richardson, consultant psychiatrist and medical director of the operational stress injury in the veterans care program at St. Joseph’s Health Care London in London, Ont. “When you’re dealing with a veteran or the family member of a veteran, you need to take the approach of trauma-informed care,” he said. “But unless you’re able to identify that the person in your clinic is a former soldier, or the spouse or mother of a soldier, then you won’t necessarily know to ask about the possibility of trauma.” Knowing about a patient’s military history will also help guide referrals, said Dr. Richardson, whose research work includes investigations into the use of advanced analytics to understand military-related PTSD, as well as algorithms to identify veterans at high risk of suicidal ideation. “There’s a network of operational stress injury clinics across Canada that focus on veterans,” he said, “Part of what we do is support community healthcare providers so that if they do have a veteran that they believe should have more specialized service, then that veteran could be referred to the clinic.” With more research today into veterans health, doctors are becoming more aware of the impact of military service on the soldier and on their families, said Dr. Richardson. He hopes this knowledge will change how physicians interact with their military patients. “We've always known that veterans had families and children and spouses, but I think now we're more sensitized as clinicians and researchers to say, to look at the impact on the veteran and the impact it has on the family,” he said. “So if somebody who has a military connection comes in with a serious illness, we need to look at the whole family and we need to look beyond just symptom improvement but also at the functioning of their support networks.” Read: Ketamine becomes new pain treatment in U.S., despite little research or regulation

Is there a military veteran on your patient roster? Here’s what you need to know

Register for free access or login.

Related Topics