Helping the Brave

Date: April 1, 2014

Seeking help often goes against the warrior ethos. It’s crucial that health care providers be prepared to identify military patients with conditions like depression and post-traumatic stress disorder in primary care settings, says retired Maj. Gen. James Gilman, executive director of the Military and Veterans Health Institute.

Physicians at the Johns Hopkins Community Physicians practice in Odenton, Md., recently contributed to the development of a program to help civilian primary care providers take better medical histories from military veterans and reservists. Gilman and Norman Poulsen, a physician at the Odenton practice, offer the following points to consider when treating patients who have been on military deployment.

• Patients who have been deployed are more likely than civilian patients to mask possible psychiatric problems. Senior-ranked service members are most inclined to minimize symptoms and their impact.
• Providers must be aware of problems a patient may face and be proactive in bringing them up. They should ask direct questions about mood, self-medication (alcohol and other substances) and relationships. For example: “Do you continue to find pleasure in activities you enjoyed during other phases of your life? Do you feel you’re getting the necessary support from your friends and family?”
• Physical symptoms frequently offer an acceptable way for service members to express psychological pain. Providers can use a complaint about difficulty with sleeping, for instance, to unearth and explore any psychological root causes.
• Because family members are often more forthright in describing troubling signs and symptoms than service members, providers should be ready to learn about their patients from family members whenever possible.

—Rachel Wallach

For more information: hopkinsmedicine.org/health