Revamping testing of physicians to better serve vets

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National Board of Medical Examiners in Phila. reviews test questions regarding veterans.

Though most current and former military personnel use civilian health care, many medical offices aren't prepared for the needs of veterans, soldiers, and their families.

The National Board of Medical Examiners in Philadelphia and members of the White House's Joining Forces initiative are working to fix that problem, starting with the next generation of physicians.

The 17-member task force recently held several days of meetings here to decide what was most important for doctors to learn about military-related medical issues. The questions they came up with will appear on the exams that test new doctors and medical students.

Knowing they'll be tested will likely spur medical students to study issues around military medicine and to insist that their professors cover these areas.

"Many of the questions we see in the military we see in everyday medicine, as well," said Steven Haist, a physician and vice president of development at the examiners board, which develops and runs the U.S. Medical Licensing Exam.

"They may have the same pathology and symptoms and signs, but the cause is going to be different. For example, there are subtle differences in PTSD between combat military and nonmilitary."

The task force includes physicians from the Army, Navy, and Air Force as well as Veterans Administration doctors and several nonmilitary, non-VA physicians who are veterans.

At a recent meeting, the doctors discussed topics that ranged from traumatic brain injuries and infectious diseases to sleep disorders and bed-wetting.

Task force member Jeremy Cannon, a trauma surgeon at Penn Presbyterian Medical Center, said the point was to make sure physicians were well-equipped to help all patients.

"The committee is balanced enough not to have super-niche questions," he said. "We're talking about good vital information that every medical school graduate should know - and if they don't know, they should know."

With a smaller share of the population serving in the military than ever before, a gap between military and civilian culture has developed, according to the Pew Foundation.

Getting civilian doctors to respond to the needs of military personnel has become a crusade for Brian Baird, a former congressman from Washington state and a clinical neuropsychologist who first recognized this issue in 2009.

"I realized that when we had about two million Americans deployed in Iraq and Afghanistan and other areas, that as we used more National Guard members and reservists, that as they returned home to their rural areas, far from VA or [Department of Defense] facilities, soldiers were seeing people who had no experience with physiological or mental issues, brain trauma, PTSD, or infectious disease," said Baird.

"At that time, we didn't even ask people on standard intake evaluations if they'd been deployed," said Baird. "Imagine a child at a local school who might not be getting along with other kids or not sleeping. Under present protocols, he might not be asked, 'Is your mom or dad deployed?'

"That changes things when you know that," said Baird.

He pushed medical schools to add military medicine issues to their curricula, writing and meeting with a number of schools and with officials from the Centers for Disease Control and Prevention. Success, however, was mixed.

"Most didn't see the urgency," he said.

Four years ago, he found two partners: the White House's Joining Forces initiative and the examiners board's Haist.

For four years, Haist has been organizing physician task forces and bringing in experts to help develop questions for the new portion of the licensing exam.

"A doctor's knowledge that someone served in the military is important," he said. "Even many years later, an illness may be related to something that occurred during their service. For example, having been exposed to Agent Orange during the Vietnam War might be associated with having a stroke later in life."

"It's important that physicians know if patients are in the military or if they'd ever served in the military," said Haist. "Otherwise, they might not put two and two together."

Although there are no current plans to add military medicine to the continuing medical education (CME) required of doctors already in practice, Baird said conscientious physicians should seek out this information themselves.

"There is no reason that doctors can't voluntarily seek out continuing medical education in areas relative to deployment," he said. "They shouldn't have to wait or be forced to learn about these areas. They should say that these men and women have served their country, and we owe it to them in terms of our own professional integrity to make sure we have the training to support and treat them."

Baird sees such education efforts as key to increasing the nation's defenses. If there are more civilian doctors trained and responsive to the needs of military medicine, he argues, it will mean better preparedness for a combat emergency.

"It strikes me as a no-brainer," he said. "When you think about it, it's something that should have been done a long, long time ago."

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