To the Editor:
Since 2001, more than 2.7 million U.S. service members—active duty and National Guard and Reserves—have served at least 12 months or more in Operation Iraqi Freedom, Operation Enduring Freedom, and Operation New Dawn.1 Upon return home, combat National Guard and Reserve veterans may face challenges in their postdeployment reintegration, defined as the period when they separate from active duty and return to the part-time reserve military and full-time civilian life. Hence, preparing physicians-in-training to identify, diagnose, and medically manage visible or invisible war wounds of transitioning combatants can enhance veteran-centric health care service delivery at Department of Veterans Affairs (VA) or non-VA health facilities.
To receive prompt care for these unique health needs, the U.S. Congress has authorized legislation, including the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113-146) and the VA Choice and Quality Employment Act of 2017 (Public Law 115-46). These policies allow veterans to seek health care services at non-VA health facilities. We propose that physicians-in-training should excel in three clinical skills that strengthen the provider–patient communication, rapport, and support for their unique challenges during the postdeployment reintegration process.
First, physicians-in-training must understand the principles of military culture in order to understand and apply the three-phase “empathy cycle”—empathetic listening in their patient interactions, empathetic understanding of the shared conversation, and patients’ understanding of this interaction.2 They must be observant for combat veterans who may openly or more discreetly discuss their physical and psychosocial health concerns. Second, by being able to recognize communication barriers and related stigma, physicians can promote innovative approaches,3 such as eliciting their unique story, when addressing their health concerns. Third, they should be mindful of scientific research and consensus studies (e.g., National Academies of Sciences, Engineering, and Medicine) and legislation (e.g., Veterans Opportunity to Work to Hire Heroes Act of 2011) that support Veterans’ transition needs. They should also be cognizant of established health and social services at community, state, and national levels (e.g., United Way) as resources that address veterans’ homecoming needs.
Physicians-in-training should promote the holistic view of veterans’ physical and psychosocial health challenges, collaborate with interdisciplinary health teams, and develop individualized management plans to optimize treatment options for combat veterans at VA and non-VA health facilities. By linking combat veterans with essential outreach resources to manage their existing hurdles, they can optimize veterans’ health care experiences while providing a warm welcome home during this postdeployment period.
Marianne Mathewson-Chapman, PhD, MSN, ARNP
Independent nurse consultant, Treasure Island, Florida; firstname.lastname@example.org.
Helena J. Chapman, MD, MPH, PhD
Science and technology policy fellow, American Association for the Advancement of Science, Washington, DC.
1. U.S. Department of Veterans Affairs, Veterans Health Administration, Office of Patient Care Services, Post-Deployment Health Group, Epidemiology Program. Analysis of VA Health Care Utilization Among Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) Veterans, Cumulative From 1st Qtr FY 2002 Through 3rd Qtr FY 2015. 2017.Washington, DC: Department of Veterans Affairs.
2. Barrett-Lennard GT. The phases and focus of empathy. Br J Med Psychol. 1993;66(pt 1):3–14.
3. Tallman K, Janisse T, Frankel RM, Sung SH, Krupat E, Hsu JT. Communication practices of physicians with high patient-satisfaction ratings. Perm J. 2007;11:19–29.