A letter to civilian providers

Dear Community Medical Providers,

How many Veterans do you have walking through your door who are either newly discharged from the military or have been going to the VA clinic for treatment? Probably not many. In all your multi-cultural training, did you consider Veterans as a having a culture all of their own? My hope is that the thought has crossed your mind. Even with an awareness of a difference, it is easy to fall out of practice of being culturally sensitive if you are not a Veteran yourself or not interacting with them on a regular basis. With the increase in the ability of Veterans to access non-VA doctors, it is reasonable to expect more Veterans to walk through your doors. Veterans, especially those who have spent significant periods of time serving or being seen in VA clinics, are likely to have become accustomed to a different manner of engaging in treatment than civilians. Adapting to the style of interaction and manner of this engagement is important to promoting the success of Veteran’s treatment. With this in mind, I offer areas to consider so we may best help serve those who served our country:

Please be direct. Be blunt. If you use any attempt to sugar coat or handle Veterans with kid gloves, you will lose them with the first grain of sugar. Understand that sugar coating is often interpreted as “This practitioner believes that I am not strong enough to handle what I am about to hear”.

Take time to explain. Standard procedure; got it. This “take time to explain” is more about the process than the diagnosis or type of test. It’s standard procedure to explore underlying causes through routine testing, such as basic blood work. Being thorough is a good thing. Many civilians understand that this is part of the process. More than once I have heard a Veteran express confusion regarding a civilian doctor checking things which seem unrelated to their complaint or ailment. There are times when Veterans have misinterpreted this as not being heard or believed about their perception of what was possibly the issue.

Ask “do you have any questions?”. That’s a question I get from my doctor every time. I ask them. Lots of other people ask them. In the military... you rarely ask them. Decisions are made by whoever is in charge of that area. Doctors are in charge of medical treatment. If the doctor has decided on a certain treatment, then the decision has been made. Yet, the civilian doctor will ask “do you have any questions?” because the patient is in charge of the patient’s body. Encourage them to ask questions and to question their agreement with the treatment plan so that the Veteran takes control of their health. Help them to collaborate with you rather than just do as they are told.

Give expressed permission for them to turn down treatment, testing, or a course of action. Veterans are seen all the time by the VA and are prescribed medication, fill them, stop taking them for a variety of reasons, and then don’t say anything to the doctor. The reasons they go about things in this manner varies, but the mindset isn’t always easy to shift when seeing someone outside the VA. Seems to me it would be better for you to know if they stop taking a certain medication rather than having them hide it. Permitting refusal allows for them to share this information. Additionally, a Veteran may just not return rather than refuse a treatment to their doctor. Reinforcing their voice in the decision making process can make all the difference. It’s the difference between choosing not to see the doctor because of their plan and choosing to make a different treatment plan with that doctor.  Along with “do you have any questions?”, it may good to also ask “what do you think about that plan (or treatment, etc)?”. If you get anything close to “you’re the Doc” or “if that’s what you think I need”,  stop and inquire more about what THEY think they need. There is a difference between consenting to treatment and agreeing with treatment. Don’t confuse consent with agreement.

Now, switch gears. Once you have a treatment plan, assign the task. Tell them directly they are to go make the next phone call or appointment needed to move forward with the plan. Put a timeline on it and be specific about what needs to happen next.

The world of a Veteran went from black and white to very very gray when they were discharged from the military. The culture they lived within is very different from our own. Some Veterans are able to switch over quite well. Others struggle. Just as we interact differently to accommodate those we work with who are from another country or religion, we should do so with our Veterans as well.

These are the very basic struggles with medical care which have come to my attention. Further understanding of their overall struggles may be beneficial to your success with these men and women. Familiarize yourself with Veteran reintegration issues and military culture. It could make all the difference in how effective we are in doing our jobs.

Posted on November 11, 2018 and filed under PTSD, awareness.