By Wendy Sarubbi | November 21, 2016 9:29 am

A panel of Orlando VA Medical Center health care professionals and military veterans spoke recently with first- and second-year med students about how veteran care differs from working with civilian populations.

For Haley Dodson, student president of the Military Medicine Interest Group and an eight-year U.S. Navy submarine veteran, the discussion was a chance to raise awareness of the ravages of post-traumatic stress disorder (PTSD) on the veteran population.

The U.S. Department of Veterans Affairs estimates PTSD affects 31 percent of Vietnam veterans and about 20 percent of those returning from Iraq.

img_7333-1“These conditions not only affect veterans personally, but can pay a heavy toll on their families as well,” Dodson said. “It is my hope that the panel shed some light on these issues and helped to educate us as future doctors on how we can best treat them.”

During their first years in medical school, students learn about different patient populations they’ll encounter as physicians, such as the LGBTQ+ community and seniors. Veterans, however, face some unique physical and mental challenges, including PTSD, chemical exposure and traumatic brain injuries.

“With the veteran population, they put themselves in harm’s way, and they end up with these sometimes horrendous injuries,” said Dr. David Portee, a VA physiatrist. “A lot of things happen to the body when an IED explodes ten feet from you. You get the brain injury, you get shrapnel injuries. You get the amputations and PTSD. And over the years, it snowballs into depression, anxiety, substance abuse. And then that affects the family.”

Mental trauma can also result in veterans neglecting to take care of their physical health. More than 80 percent of veterans coming to the Orlando VA Medical Center are missing five or more teeth, according to Dr. Marshall Gallant, chief of dental service.

To understand the full scope of veterans’ health needs, a physician needs to adopt a holistic approach, the panel told students.

img_7335-1“If you violate their trust early, a wall will build,” said Dr. Bryan Batien, clinical psychologist and eight-year Army veteran. “But if you take the time to try to listen to who they are, where they’re coming from, maybe that’ll also give you insight into what’s going on health-wise.”

Also important is understanding the cultural and political climate when the veteran served.

“The Vietnam War was a war of conscription,” said Dr. David Simmons, an internist. “There are a lot of Vietnam veterans you don’t just automatically thank for their service. They’re still really angry at their country.”

Older veterans tend to have a higher pain tolerance and may conceal what they’re really feeling.

“With World War II and Korean War vets – many of them were brought up to just handle it, to hide your pain,” said Dr. Gallant, who spent eight years in the Army Reserves. “I had a World War II veteran jump out of my chair because he didn’t want anesthesia. He was livid. I’d never seen anything like it.

img_7313-1“The newer veterans are not like that at all. They’re used to getting more medical interaction and have broader expectations for what they should receive.”

Because of these challenges, gaining and maintaining rapport with a veteran patient is paramount.

“That veteran is only going to be as compliant as they trust you,” said Charles Tubbs, VA program manager and a 21-year Air Force veteran. “If there’s not a trusting relationship between the veteran and yourself as a provider, you may not get the health outcomes you seek to gain.”

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