All medical providers should have training in issues related to military deployment

EVEN as a federal Court of Appeals ruled recently that Veterans Affairs care for veterans is inadequate, a possibly greater gap in care for service members has gone completely unrecognized.

In the past decade, approximately 2 million American military and civilian personnel have deployed to combat areas. Those individuals, plus their family members, face unique physical, emotional and economic challenges that can have lasting, potentially lethal, impacts.

If any other health-care condition affected so many and carried such serious potential risks, one would expect our academic and public-health institutions to pull out all the stops to ensure proper diagnosis and treatment. Nothing of the sort has happened.

In fact, the majority of our leading medical schools and other health-training programs provide no mandatory or even elective course work relating specifically to military service or deployment issues. As a colleague in Congress said when I asked about his own medical training, "I took course work on all sorts of diseases I'll never see in my career, but I never had a single class or even a chapter on military culture or combat deployment."

Some physicians and other health professionals gain exposure to these issues during residencies or other training at Department of Defense or VA facilities, but this is by no means universal or adequate. With so many people having been deployed and the heavy reliance on National Guard and Reserves, many of those who served will return to homes far from military bases or VA centers. So too, civilian government workers or contractors and their families have no access to such resources.

For many, the first line of health-care practitioners are likely to be family doctors, psychologists, school counselors, etc., most of whom have no training in these issues.

The sad fact is, we don't prepare our health professionals to recognize the issues, we don't teach them how to provide appropriate care, and we don't even think to ask the right questions. How often have you seen a health-intake form asking, "Have you or a family member been deployed to a combat area?"

Congress and the Obama administration should correct this now and permanently with four specific goals to be achieved within two years:

• Every health-care education and training program should include mandatory course work addressing the medical and psychological issues relating to military service and deployment, including impacts on the uniformed service, civilian personnel and their families.

• Continuing Education for existing health-care professionals should offer empirically based, practical and up-to-date course work pertaining to military service and deployment.

• Every health-licensing board and association should incorporate these issues as a requirement in the examination and testing for licensing and certification.

• Every routine intake examination should include specific questions asking if the individual patient or any family member has been deployed to a combat area.

The Obama administration should lead this by hosting host a high-level meeting of all health professions, training institutions and licensing boards plus the relevant government agencies, including the VA, DOD, Centers for Disease and Control and National Institute of Mental Health.

To overcome the inertia inherent in academia and professional organizations, Congress should give real teeth to the matter through appropriations language requiring that any health-care-education program receiving federal training or research dollars must include specific and substantive training in military and deployment issues. To ensure existing professional staff receive continuing education on these issues, similar requirements should apply to all health-delivery institutions that receive federal dollars.

The good news is, effective interventions exist to help our military and civilians who deploy in service to our country. It is long past time to get that news to health-care providers and the public and ensure it becomes a central and permanent element of all training and practice.