Nationwide Campaign Urges Doctors to Ask if Patients are Veterans

The American Medical Association has urged health care providers to ask patients if they have served in the military and to include that experience in their records.

The inclusion of military service experience -- including assignments and duties -- into the AMA's official guidelines was adopted at the request of the American Psychoanalytic Association, made up of about 3,300 members, including psychiatrists, psychologists, social workers, educators and researchers.

"Military history will usually not be volunteered by patients if not specifically asked for," Dr. Prudence Gourguechon, a psychoanalyst and former APA president, said in a statement. "However, serving in the military poses several additional challenges and stressors that can impact the overall health and mental well-being of military personnel and their families. This makes asking key questions about military experience vital to better serving their health needs."

But Gourguechon also would like doctors to put "an expanded version" of the military service question to all patients, so that it the information can be factored when providing care to sons, daughters, spouses or survivors of veterans.

"When a patient comes for medical care or behavioral health care, it is important to ask everyone, including children, if they or a loved one has served in the military," she said. "A child of a deployed parent, for example, may exhibit behavioral problems that can't be understood without knowledge of his parent's military service."

The group requested the change to the AMA's Current Procedural Terminology [CPT] Evaluation and Management Services Guidelines in 2013.

"Hopefully the clinicians will pick it up," said Joy Ilem, assistant national legislative director for Disabled American Veterans. "It's so important that clinicians be aware of what personnel were exposed to in the military."

"We know that the VA treats over six million veterans ... but the majority of our veteran population does not go to the VA," she said. "They end up going to the private sector, maybe they have their own insurance." But private sector doctors may not ask about military service and dig into what they veteran was exposed to, Ilem said.

So they may never know about injuries from Korean War service, chemical exposures from chemical warfare experiments, exposure to dioxins like Agent Orange in Vietnam, or to burn pit exposure during the wars in Iraq and Afghanistan.

Ilem said the American Academy of Nursing took a similar step in September when it announced a new national campaign called: "Have you ever served in the military?" 

Both organizations credited the Veterans Affairs Department and the White House's Joining Forces Initiative for pressing the case for health care workers to ask about military service when collecting information from patients seeking medical or mental health care.

"These are all just really good campaigns that are taking off," Ilem said.

Kelly Kennedy, a spokeswoman for Bergmann & Moore, a national law firm that handles veterans' disability cases, said the AMA making military service history a part of its official guidance "is a big deal."

"If you've got a guy with a bad chronic cough or neurologic issues or even chronic back pain, that military history could provide clues on how that person's treatment should look," said Kennedy, who has written on military and veteran health issues for USA Today and Military Times. "That's especially true with Gulf War illness and the research showing there are some treatments that may be specific to them."

Collecting such information will also be helpful in treating aging Vietnam veterans who are entering hospice care and dealing with old combat trauma.

"End-of-life can bring up a whole bunch of stuff, but the vet may not think to tell his doc that he's a combat vet who experienced trauma," Kennedy said.

-- Bryant Jordan can be reached at bryant.jordan@military.com.