America hasn’t seen veterans like those returning from Af- ghanistan and Iraq. Many survived wounds that in earlier wars would have killed them. And many have lost one or more limbs or suffered traumatic head injuries. “A lot of doctors are trained in VAs, but they’re used to the Vietnam-era guys. They’re used to seeing guys with COPD [chronic obstructive pulmonary disease], some PTSD [post- traumatic stress disorder], and maybe an amputation here and there,” said Dr. Evenhouse, co-owner of Medical Security International (MSI), a training and consulting company that describes itself as integrating tactics and medicine learned on the battlefront to improve survival rates. Dr. Evenhouse says MSI em- ploys veterans and has earned its knowledge about the medical needs of vets through supporting its own people.
“The new veterans are coming out of two wars over the last 10 to 11 years with very different wounding profiles, very different injuries, par- ticularly related to traumatic brain injury and post-traumatic stress disorder,” said Dr. Evenhouse, who helps design the training modules for ISV. According to July 2011 data from
the VA, the most frequent diagnoses in post-9/11 veterans include mus- culoskeletal system issues, mental disorders, nervous system diseases, digestive system diseases, and ill-de- fined symptoms and signs. The most frequent mental disorders reported since 2002 include PTSD, depressive disorders, neurotic disorders, affec- tive psychoses, and specific non- psychotic mental disorders due to organic brain damage. Stephen Holliday, PhD, chief mental health officer for the VA’s Veterans Integrated Service Network (VISN) 17 based in San Antonio, says it is important for physicians and other health professionals to be alert for emerging mental health is- sues, particularly PTSD, depression, and substance abuse. They need to be ready to help veterans with those issues and to refer them to VA men- tal health services, if necessary. Ms. Moles says community phy- sicians must be aware of veterans’ needs because relatively few get most of their health care from a VA clinic or hospital. Fewer than half of
them access services through the VA, and only 8 percent of Afghanistan and Iraq veterans seek their primary care at VA facilities. She also sees the training and community education as pre- vention: prevention of impaired health, unemployment, and suicide. “The medical community has a significant opportunity to improve care and improve lives,” Ms. Moles said. According to the National Coalition for the Homeless, about
5 percent of homeless veterans live in rural areas where access to a VA clinic or hospital might be limited. Studies show that rural veterans have greater health care needs than their ur-
Texas medical schools join effort to stress veterans’ health needs
Several Texas medical schools are among some 130 U.S. colleges of medicine pledging to include courses on post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) in their curricula. In January, First Lady Michelle Obama announced a collaboration with the Association of American Medical Colleges (AAMC) and the American Association of Colleges of Osteopathic Medicine to put more emphasis on the conditions that affect many veterans returning from the wars in Iraq and Afghanistan. In 2012, medical schools participating in the Joining Forces initiative have committed to:
• Enrich medical education to ensure that physicians are trained in the unique clinical challenges and best practices associated with caring for military service members, veterans, and their families;
• Disseminate the most up-to-date diagnostic and therapeutic infor- mation on TBI and psychological health conditions, such as PTSD;
• Grow the body of knowledge leading to improvements in health care and wellness for our military service members, veterans, and their families; and
• Join with others to strengthen the community of physicians, insti- tutions, and health care professionals dedicated to improving the health of military service members, veterans, and their families.
Texas medical schools in the project are Baylor College of Medicine,
the Texas A&M University Health Science Center College of Medicine, Texas Tech University Health Sciences Center School of Medicine, Texas Tech’s Paul L. Foster School of Medicine, The University of Texas Medi- cal School at Houston, and the UT School of Medicine at San Antonio.
March 2012 TEXAS MEDICINE 23
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