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Friday July 21, 2017

When the Patient is a Veteran

When the Patient is a Veteran

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‘Joining Forces’ provides Rutgers health care providers with training and tools to support and treat service members and their families

Image of U.S. servicewoman saluting American flag
Rutgers Robert Wood Johnson Medical School's "Joining Forces" teaches a collaborative approach to improving the care of veterans and their families.

‘We must understand the value of building trust between veterans and their physicians. Veterans are very proud individuals who will tell us about their military service if we give them the opportunity.  Without it, we will have incomplete medical histories and will miss vital information.’
 
 – Kevin Parks
U.S. Army veteran and fourth-year student,
Robert Wood Johnson Medical School
 

The questions are short and direct, vital for a comprehensive medical history: Have you served in the military? Where? When? Yet few examining physicians routinely ask them, often missing details that could be key, while leaving veterans feeling underappreciated and lacking a connection with their physician.

Rutgers has put itself out in front of a nationwide effort to improve veterans’ care. The need is underscored by documented failures of the Veterans Administration as servicemen and servicewomen seek to re-establish their civilian lives. 

Veterans returning from their deployments may suffer from post traumatic stress disorder, exposure to toxic substances, addictions and other physical and psychological wounds of war.

“Our veterans are feeling disenfranchised and disconnected, worried that they won’t get the medical care they need,” says Carol A. Terregino, senior associate dean for education at Rutgers Robert Wood Johnson Medical School (RWJMS). “These are complicated cases. We have to teach our future community health professionals to recognize that and understand how to treat veterans.”

Last year, RWJMS became one of the country’s first medical schools to implement “Joining Forces,” required instruction that gives its fourth-year students information, tools and training to help assess and treat veterans and their families. This year, RWJMS expanded the program to include pharmacy, nursing, social work and psychology students as well as psychiatry, primary care and physical medicine and rehabilitation residents to teach a collaborative approach to diagnosis and care.

“Joining Forces” is a national initiative to support and honor America's service members and their families, which includes calling attention to the critical health and mental health issues facing veterans and military families.

RWJMS collaborated with retired military veterans Ronald Steptoe and Evelyn Lewis in customizing the Steptoe Group’s Warrior-Centric Healthcare Training. The daylong program features modules focused on veterans’ experiences in clinical settings, the neurobiology of post-traumatic stress disorder and traumatic brain injury, the cultural distinctions of veterans and their families, stigma, and effective communications.

The program, which incorporates information from The Rand Report and the Department of Defense’s Recovering Warrior Task Force Report, includes role-playing exercises to encourage collaborative treatment plans by a patient’s medical team.

Image of Kevin Parks
Photo: Jeff Tolvin
Kevin Parks, a fourth-year RWJMS student who was a U.S. Army medic in Iraq during part of his enlistment, has assisted in customizing the school's "Joining Forces" program. 
Kevin Parks, a fourth-year RWJMS student and a U.S. Army veteran who served as a combat-area medic in Iraq as part of his deployment, has become the school’s student advocate for “Joining Forces” after he himself felt alienated upon discharge.

“I noticed that medical schools were not teaching students how to treat veterans and certainly no one was teaching them to ask patients if they were veterans,” says Parks, who enlisted following the Sept. 11 attacks. “It can make a huge difference in diagnoses and treatments.”

As a soldier, Parks, who has helped customize the RWJMS "Joining Forces" curriculum, was treated for a temporary respiratory condition. Upon discharge, he had difficulty gaining VA benefits and his X-rays and treatment plan were lost, delaying an updated assessment of his condition.

Parks has already observed the benefits of the "Joining Forces" training firsthand. While taking a medical history of a male patient, he asked about military service and service-related injuries.

Only Parks’ gentle probing triggered the patient’s memory of a metal rod implanted during service to fuse a joint following thumb surgery, a potential danger to the patient should he undergo an MRI because of the powerful magnetic pull of the MRI equipment. The likelihood of a problem isn’t high, but it is now highlighted on his medical history.

“We must understand the value of building trust between veterans and their physicians,” Parks says. “Veterans are very proud individuals who will tell us about their military service if we give them the opportunity. Without it, we will have incomplete medical histories and will miss vital information.”

Rutgers’ involvement is particularly important given New Jersey’s large veterans population and the likelihood that many of its future physicians will eventually practice here. Approximately 73 percent of New Jersey’s 443,200 veterans have served during wartime. Nationwide, an estimated 15 million of the 23 million veterans seek health care in their communities.

“A growing number of veterans are turning to the private sector for the services they may have difficulty accessing from the VA,” said Robert C. Like, professor and director of the RWJMS Center for Healthy Families and Cultural Diversity in the Department of Family Medicine and Community Health. “But are we doing all we can to gain their trust and respect? Are our waiting areas veteran-friendly? Do we truly thank them for their service and sacrifice beyond just saying these words?"

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