Improving Care for Our Veterans and Military Service Members by Asking the “Unasked Question”

editor3001297835470338080 (2)By Kevin Parks

Returning home from the military and from combat was the most challenging situation I have faced in my life. Overnight, I changed from a decorated combat medic in a storied infantry division to an unemployed college student living with my parents. Unfortunately for me, and many other veterans, access to health care was one of the benefits that got left behind after my separation from service.

I am not alone. More than 2.3 million American military personnel have deployed to Iraq, Afghanistan, and other countries. Many of these veterans are unable to gain timely access to medical care when they return home, and only 37 percent of all post-9/11 veterans have entered into the Veterans Affairs system.

To whom do those veterans turn for health care? Ask the provider at my local urgent-care clinic, to whom I presented with fever, chest congestion, and a productive cough. Sometime between my deployments to Korea and Iraq, I had a positive tuberculosis screening skin test. After taking medication for nine months, I was told I would need follow-up chest x-rays. For about three years after I left the military, like many other veterans and Americans, I went uninsured. All of a sudden, this unsuspecting physician was faced with ruling out pulmonary TB on a chest x-ray on a patient who should probably be receiving his care for this problem from the VA.

What can we do to connect our veterans with the care they need? Let’s start small: Ask! Providers must ask the “unasked questions” of patients: Did you serve in the military? Where? When? Questions get more detailed after that, but discovering a patient’s military history at the outset of the encounter can save valuable time and guesswork.

As a medical student, the guidance I’ve been given to learn about physical diagnosis – the one that asks everything of the patient – is missing key questions about people like me. If you were to begin by asking, “Have you ever served in the military?” you’d be amazed by the results. Some patients even do us the favor of wearing military paraphernalia, such as a “Vietnam Veteran” or “USS Nimitz” hat. These veterans doing everything they can to get to you to ask them about their service. However, not everyone comes with labels, and you will not know unless you ask.

We also can address this problem formally in medical school. Fortunately, that’s exactly what happened at the medical school I attend: Rutgers Robert Wood Johnson Medical School (Rutgers RWJMS). What Rutgers RWJMS did wasn’t just a wave of the hand; the school rolled out a program coordinated to include medical, pharmacy, nursing, applied psychology, social work, and physician assistant students.

Rutgers RWJMS faculty created a customized program, including the use of in-house educators and veterans from the local community. The trainers conducted a daylong inter-professional educational event consisting of a mix of lectures, panel discussions with veterans and family members, small group work, and clinical role-plays.

My role as a medical student, veteran, and member of the Rutgers community was to coordinate the involvement of local veterans. Like many universities nationwide, Rutgers has a veteran–student group and veteran services center. I reached out to these resources to see if veterans would volunteer to share their experiences, thoughts, and stories. The response rate was nothing short of staggering. Together, we grounded the day’s events in a short introductory video. Our stories showed, in a way no lecture or assigned reading could demonstrate, the lasting effects of our military service. Peers and faculty members in the audience still speak of the visceral reactions to this video.

We were lucky to have four veterans, and one mother of a veteran, who were brave enough to share personal stories in a panel discussion, which I co-moderated with a physician faculty member with expertise in cultural competency. This discussion was meant to outline how to conduct an interview with a veteran, and what intimate and meaningful information can be gained from that discussion. The small group discussions brought together an interdisciplinary mix of students to practice developing trusting and therapeutic relationships, patient-centered interviewing and communication skills, biopsychosocial assessment, and team collaborative care planning. Veterans actively participated in these sessions and shared their valuable insights and experiences.            

Certainly, the program at Rutgers RWJMS was just the first step in a commitment to train cohorts of graduating health professionals. Medical educators need to accept the reality that the responsibility for caring for our nation’s veterans falls on all of the medical community, not just the VA. In order to provide effective, culturally competent, patient-centered care, we must raise awareness of veterans’ health issues and disparities. Veterans nationwide stand ready to help. Together, we can provide better care for our patients, families, and communities.

KRP_Photo—Kevin Parks is a third year medical student at Rutgers Robert Wood Johnson Medical School in New Jersey and is a veteran of Operation Iraqi Freedom, having served with the 101st Airborne Division. He was recently awarded the “New Jersey Heart of a Hero Scholarship” in recognition of his volunteer efforts. He hopes to continue his volunteer and educational roles throughout his career. He can be reached at parkskr@rwjms.rutgers.edu.

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