Seven weeks after his induction into the Army in 1966, Dr. Jeffrey L.
Brown was sent to Vietnam, where he spent a year treating front-line
soldiers, sometimes under fire. He knew next to nothing about weapons
when he went, but returned a battlefield doctor. Back home, he got
married, started a family and opened a pediatric practice.
Decades later, Dr. Brown, now 72, developed ailments which, he thought, seemed “consistent with his age.” So he was surprised to learn not long ago — from reading a newspaper article — that at least one of those ailments, ischemic heart disease, has been linked to exposure to the defoliant Agent Orange, which was used widely in Vietnam.
It dawned on him that no physician had ever asked him whether he was a veteran, much less taken his military health history (which included not only exposure to Agent Orange, but also dengue fever.) Even the resident physician who performed his intake exam at a Department of Veterans Affairs clinic did not do that kind of thorough history.
“I had never had a civilian doctor ask if I was a veteran, ask pertinent follow-up questions, provide me with preventive counseling or screen me for medical and psychological illness that might have occurred from my deployment,” he wrote in an e-mail.
Those musings prompted Dr. Brown, who teaches pediatrics at New York Medical College and Weill Cornell Medical College, to write an essay titled “The Unasked Questions” that was published last week in the Journal of the American Medical Association.
In it, Dr. Brown lays out a simple proposal: The American medical system, he says, needs to begin systematically asking adult patients whether they are veterans and, if they are, ask them some detailed questions about their health histories during their service.
The public health implications, he says, are significant. There are more than 21 million veterans in the United States today, including nearly one in six of all males between the ages of 35 and 64. But the majority – about 60 percent — receive their health care from private doctors, not from the Department of Veterans Affairs.
Yet few of those private doctors even know whether their patients are veterans — whose military experiences, particularly in combat zones, could have had profound effects on their health many years later.
“As good medical practice, a factory worker with a two-year history of exposure to low-grade radiation or chemical and smoke inhalation would have his or her occupational history noted and flagged for long-term follow-up; medical conditions like cancer and emphysema might not become evident until many years later,” Dr. Brown writes in his essay.
“But if these same health risks occurred during a Gulf War deployment, this information might never find its way into the patient’s health record.”
Had such military medical histories been routinely prepared in the past, many Vietnam veterans with illnesses that have been linked to their service might have received treatment or disability benefits many years earlier, he says.
Dr. Brown offers a few policy changes. First, he says, medical schools should start teaching students how to take a military health history. Those medical histories might begin with simple questions like these: When and where were you stationed? Were you physically injured? Were ever exposed to Agent Orange? Were you ever treated for parasitic or tropical diseases? Were you affected psychologically by your military experiences?
He also recommends that medical schools encourage discussion about the major stresses facing veterans today, such as suicide, substance abuse and occupational disability. And he says that residents who receive training at Department of Veterans Affairs hospitals take enhanced courses in dealing with veterans.
Since the essay was published, Dr. Brown says, he has received letters from other doctors who are military veterans saying that they, too, have been amazed by how rarely civilian doctors ask their patients whether they ever served in the military.
Until that question is routinely asked, Dr. Brown concludes in his essay, “Patients who have been wearing their ‘I am a Veteran’ caps when visiting the physician will have good reason to continue doing so.”
http://atwar.blogs.nytimes.com/2012/11/19/medical-history-should-include-military-history-doctor-says/
Decades later, Dr. Brown, now 72, developed ailments which, he thought, seemed “consistent with his age.” So he was surprised to learn not long ago — from reading a newspaper article — that at least one of those ailments, ischemic heart disease, has been linked to exposure to the defoliant Agent Orange, which was used widely in Vietnam.
It dawned on him that no physician had ever asked him whether he was a veteran, much less taken his military health history (which included not only exposure to Agent Orange, but also dengue fever.) Even the resident physician who performed his intake exam at a Department of Veterans Affairs clinic did not do that kind of thorough history.
“I had never had a civilian doctor ask if I was a veteran, ask pertinent follow-up questions, provide me with preventive counseling or screen me for medical and psychological illness that might have occurred from my deployment,” he wrote in an e-mail.
Those musings prompted Dr. Brown, who teaches pediatrics at New York Medical College and Weill Cornell Medical College, to write an essay titled “The Unasked Questions” that was published last week in the Journal of the American Medical Association.
In it, Dr. Brown lays out a simple proposal: The American medical system, he says, needs to begin systematically asking adult patients whether they are veterans and, if they are, ask them some detailed questions about their health histories during their service.
The public health implications, he says, are significant. There are more than 21 million veterans in the United States today, including nearly one in six of all males between the ages of 35 and 64. But the majority – about 60 percent — receive their health care from private doctors, not from the Department of Veterans Affairs.
Yet few of those private doctors even know whether their patients are veterans — whose military experiences, particularly in combat zones, could have had profound effects on their health many years later.
“As good medical practice, a factory worker with a two-year history of exposure to low-grade radiation or chemical and smoke inhalation would have his or her occupational history noted and flagged for long-term follow-up; medical conditions like cancer and emphysema might not become evident until many years later,” Dr. Brown writes in his essay.
“But if these same health risks occurred during a Gulf War deployment, this information might never find its way into the patient’s health record.”
Had such military medical histories been routinely prepared in the past, many Vietnam veterans with illnesses that have been linked to their service might have received treatment or disability benefits many years earlier, he says.
Dr. Brown offers a few policy changes. First, he says, medical schools should start teaching students how to take a military health history. Those medical histories might begin with simple questions like these: When and where were you stationed? Were you physically injured? Were ever exposed to Agent Orange? Were you ever treated for parasitic or tropical diseases? Were you affected psychologically by your military experiences?
He also recommends that medical schools encourage discussion about the major stresses facing veterans today, such as suicide, substance abuse and occupational disability. And he says that residents who receive training at Department of Veterans Affairs hospitals take enhanced courses in dealing with veterans.
Since the essay was published, Dr. Brown says, he has received letters from other doctors who are military veterans saying that they, too, have been amazed by how rarely civilian doctors ask their patients whether they ever served in the military.
Until that question is routinely asked, Dr. Brown concludes in his essay, “Patients who have been wearing their ‘I am a Veteran’ caps when visiting the physician will have good reason to continue doing so.”
http://atwar.blogs.nytimes.com/2012/11/19/medical-history-should-include-military-history-doctor-says/
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