Posts tagged #Veterans

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.

Helpful Hints for Veterans and Civilian Medicine

I am starting to see an increased number of VA connected Veterans utilizing civilian doctors through their private health insurance for a variety of reasons.Recently, I had the opportunity to be involved in one Veteran’s experience navigating the world of civilian medical doctors. Seeing a civilian doctor is something that is almost second hand nature to those who have not served. Most of us have been seen by a civilian doctor since a young age and learned how to work with a doctor as an independent living skill. Therefore, we have an awareness of when to call a doctor, either for a regular check up or when ill. This basic understanding runs deeper than just scheduling. Civilians have a natural grasp of the process, the doctors’ intentions, and the regular follow ups. Based on my observations of this individual and reports of other Veterans, I would like to offer the following tips to effectively navigate the world of civilian medicine:


Regular check ups are not scheduled for you and sent by notice in the mail. You need an appointment; you call yourself. If you are supposed to follow up, you are responsible to set that appointment. If treating your ailment requires regular intervals of treatment, again, it is not standard practice to send notice in the mail. Yup, you have to make sure you stay on top of it.


It is a lot easier when you’re given an order and it is expected that you follow. When you are in charge of your health (civilian medicine), you have choices. I work with many Veterans who are prescribed medication and afraid to refuse or make it known that they don’t want to take it. Many Veterans are told they need certain testing and they do so because they were told they “have to”. Civilian doctors’ recommendations are just that - recommendations. Refusal of medication or testing comes with no consequences outside of the impact it may have on your health. Requests for exploration of different medications are widely accepted. Second opinion? You get to have those too. Civilian doctors know that it’s just part of the profession. Patients may seek a second opinion and not compromise their relationship with their primary physician. Seeking a second opinion is often a smart idea when dealing with major illness because it GIVES YOU OPTIONS, which allows you to choose what’s right for you rather than just being told what is right for you. It’s always YOUR body in the world of the civilian physician.


Civilian physicians have much more freedom in their approach to their patients. Go in for a pain in your back and they may draw to test basic blood work. They may discuss potential causes which, to the patient, may seem unrelated. Fairly routine. Underlying causes are also something to consider. Something they can consider. If you feel you are not being heard, you can ask them to take another look, answer your questions, and review your concerns. You are paying them for a service. Collaborate with them rather than follow them. They aren’t a superior giving orders.  If you feel you are still not being heard? There are lots of fish in the sea as they say. Go to another doctor. There are plenty and you get to choose who you see.


“If I get treatment and it works, I lose my rating”

When using the VA as a mental health provider, Veterans have been warned that they may not  be candidates for certain treatment (i.e., EMDR) because of the fear that losing their VA rating may compromise their ability to progress in treatment. Yes, the general understanding is that your VA disability benefits can be reduced if you get healthier. My research has not yielded any statistics regarding the rate of benefit reduction. My position is: If a Veteran is seeing me (with the exception of being court ordered) then their level of discomfort has reached a point where they want to make progress. A civilian practitioner is usually not connected to the VA or your benefits; hence, the overriding position is to improve your health and quality of life. Feeling better may not be a bad thing.


Doctors are human. The Veteran who prompted my desire to provide these tips was scheduled for a review of his medical testing with a doctor other than the doctor who initially examined them. This Veteran had been scheduled to see an alternate doctor to accommodate the Veteran’s limited schedule. But when the alternate doctor called to say the Veteran had to see his original doctor, the Veteran accepted this and scheduled an appointment a month out to see the original doctor. Didn’t make sense, but the Veteran did as they were told. Upon prompting, the Veteran called back and explained their confusion. The office acknowledged that the Veteran was correct! Who’d a thunk it. They rescheduled to an earlier appointment with another doctor and things moved forward. Question, question, question. It goes back to taking charge. Trust that  you know what you need for your own health

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

Veterans: Where to Start?

Over and over we hear about how the returning Veteran is suffering from trauma, physical disabilities, anxiety, and so on. There is an abundance of information supporting the fact that Veterans face a higher incidence of divorce, drug use, and suicide. This has prompted significant focus on access to mental health for Veterans. When we think of these issues, what comes to mind? It is easy to jump to PTSD, anxiety, and other mental illness. So, at first, it was agreed:

We Start There!

Let's back up a second, though. While these are significant issues which we absolutely need to address, it is becoming more apparent in my work and in the world of research that this may not be the place to start.


“When I was in, it was easy. I had two jobs: Do as I was told and Stay undead”

“Civilians are crazy”

“Nobody makes any sense”

“When I was told what to do, we did it… at that moment. My civilian co-workers don’t do that”

“They think I am bossy when I am just trying to get everyone together and working. When I was in, I gave orders all the time and we got it done.”

“My family is so hard to talk to because they don’t get it”

“I offend people and don’t know why”


These statements represent what I hear in counseling sessions with Veterans. This is not someone talking about flashbacks, hyper-vigilance, nightmares, fear of going outside, or Depression. One, if not more, of those symptoms are usually present, but those are actually not always the issues for which these Veterans are seeking help. Whether these symptoms are managed or not, it is the struggle they described in the above statements which they need help with most. What they are describing is a struggle with

Successful Reintegration.

Among other things, this is the ability to resume prior social roles, connect and become part of their community, engage in leisure activities, and find meaning or purpose in civilian life. 

Remember before when we said:

We Start There!”?

We may have gotten this wrong for many of our returning Veterans. They are coming into counseling sessions expressing frustration about the basic issues civilians naturally understand since they have never been separated from this civilian society. Yes, these other mental health related issues may impact reintegration but one does not automatically have PTSD or other mental health issues just because they served. Reintegration does not only effect those who have been deployed to conflict areas. Living in the culture of the military alone makes reintegration difficult. Addressing the major mental health issues may not be possible if some basic readjustment can’t occur. Let’s listen to the experiences that these Veterans are reporting and help them start by addressing basic needs.

In a recent training with trauma expert, Bessel van der Kolk, M.D., he astutely pointed out that the Veteran doesn’t always need to learn to manage their trauma; sometimes they just need to learn how to manage dealing with people in a grocery store. If the perception “Civilians are Crazy”  is accurate to a Veteran’s reality, then, in a grocery store, we have just asked him/her to spend significant time in close quarters with “crazy” on a regular basis and survive it.

So how do we better meet the needs of these men and women? How do we break down resistance to engaging in work aimed at giving them the relaxed and enjoyable life they deserve and protected for the rest of us? It may be we move from the clinical to the practical. We acknowledge and understand:

  • the intensive training they completed to build protective factors meant for a war zone- so they can come home and protect home
  • the highly structured, black and white world within which they lived versus the gray world which runs on unspoken rules beyond laws, and the struggles of then returning to gray world living once again
  • that navigating social situations and making interpersonal connections outside the tribe are not skills which offer protection in a time of war. They can, at times, become a risk instead.
  • that if they learned and did well, then they had to suppress and, potentially, forget the rest.

Let’s remove the stigma of mental illness from the counseling session and replace it with skill building and redirecting one’s strengths, which have now become barriers.

Fortunately, our community does not have a deficit of resources. The Mountain Resource Center maintains a Veteran’s Support Services Program offering a variety of services which include job searching, emergency services, and funding for counseling (not just counseling for mental illness). For further information, you can contact them at (303)838-7552.

Additionally, Park County has a very involved and informed Veterans Support Officer who can be reached at (303) 816-9498.


Written by: Alison Atkins

Learn more about Alison here!