As a former Army wife, I have seen firsthand the toll that military service takes on service members’ health. During my two years as an Army wife, I watched every morning as my husband rolled out of bed at 4:30 or 5 a.m. to go to his daily physical training session. I heard about the “thrills” of basic training, of the continual preparations to keep him and others in his unit able to fight; and I saw every time he flinched from loud noises, heard every time he cried out in his sleep, and watched as his body stopped being able to take as much abuse as it could when he first joined in his early twenties. Because of these experiences, I was struck by a recent commentary in JAMA, which related Jeff Brown’s personal observations that physicians do not know to ask about military service. It worries me that military service correlates highly with chronic conditions such as hypertension and diabetes, but my husband’s provider may not know to monitor for these conditions because of my husband’s military service.
My colleagues and I explored this idea of provider awareness of military service, or the “unasked question,” in a recent Association of American Medical Colleges (AAMC) Analysis in Brief. We analyzed data from the bi-annual AAMC Consumer Survey to look at the numbers of military personnel (current and former military) who had been asked about military service by health professionals, as well as the overall ability of this population to access health care.
We examined health care access by asking whether respondents always or sometimes had access to care, had health insurance, and had a usual source of care. Results showed that a majority of respondents did not recall being asked if they had served in the military (57 percent of military personnel and 80 percent of all non-military). Also, military personnel past and present generally had better access to health care than did the non-military participants, but most of the military participants sought care using private insurance, making them potentially undistinguishable from other patients unless the provider asked them whether they had served in the military.
Our study showed that most military personnel are never asked about military service and will likely not be pre-emptively monitored for associated chronic conditions. Without asking or being told, my husband’s provider would not know that the man who enters his office with the t-shirt, jeans, and private insurance card wore an Army Combat Uniform (ACU) a few months ago. Also, though our study shows veterans and current military are better able to access health care, access is still not perfect, and the physical and mental stress of training and combat leaves a lasting impression that affects and limits their abilities.
Although we only asked if the participant had been asked about military service, education needs to go both ways. Military service patients need to be engaged in their health care and let health care professionals know about service. Health care professionals need to ask on intake about military service so that screenings and monitoring can be done for both mental and physical chronic conditions.
In observance of Veterans’ Day, take time to celebrate and remember the sacrifices made by brave men and women for our country and for our freedom, but also remember that all those who are living have made sacrifices that could impact their current and long-term health. Providers must ask about military service so that this vulnerable population will not fall through the cracks in the health care system.
—Stacie Pankow is a research associate for the Georgia Prevention Center at Georgia Regents University in Augusta, Georgia. At the time of this study, she worked for the Center for Workforce Studies at the Association of American Medical Colleges. In addition to the connection to the military through her husband’s prior service, she has female and male friends who serve in all branches, and is the granddaughter of a WWII naval veteran.