Caring for the Caregiver

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I am increasingly worried about the toll on my Army medical colleagues still left on active duty. The American public and the media legitimately focus on the enlisted Soldier and those who have borne the brunt of the direct fighting.

But we must also concern themselves with the welfare of the nurses, doctors, medics and other staff who care for service members both in theater and back in garrison. And currently disheartening to the doctors, wading through the ever-increasing avalanche of paperwork.

Let me talk a little about the medical staff—of all the Services– on active duty and in the reserves.

Uniformly I have found them to be very bright, motivated, and patriotic enough to have both joined the military and stayed in, 10 years after 9/11, and through two long wars.

They have deployed, like every other service member. Usually several times.

Medical personnel are not kicking in doors, it is true. But they have been shelled, and shot, and sometimes killed.

Most recently we lost Lieutenant Colonel David Cabrera, an Army social worker. That death was due to enemy fire.

They are also caring in for the men and women who lost limbs, faces, or minds, kicking in doors.

In the theater of war, medics are not just treating our service members. They tend to local citizens in Afghanistan, including badly injured children, other NATO troops and third-party nationals. And for detainees who want to get back at us — any way they can — including trying to stab medical personnel with homemade shanks.

There are other toxic elements for our medics. The shootings at Camp Liberty and Fort Hood in 2009 burn in the memories of the involved units. In the Camp Liberty shooting three years ago, we lost an Army psychiatrist and a Navy social worker, along with three others.  The Fort Hood shooting, by an Army psychiatrist, took 13 lives, and effectively ended the careers of many others in the wake of the investigations that followed.

I believe these shootings were much harder on the Army Medical Department emotionally, because the damage was caused, not by the Taliban, but by a Soldier patient, and an Army psychiatrist. Certainly it was much harder on me.

However when I talk to my active duty medical colleagues, it is no longer the possibility of deployment that worries them. Instead they welcome the idea of a “vacation” in Afghanistan, because it would take them away from the ever-increasing requirements around medical boards, and reviews of medical boards, and re-reviews….

In the wake of the Joint Base Lewis McCord controversy over PTSD diagnoses, the Army leadership recently decreed that all medical boards going back to 2001 needed to be reviewed. About 181,000 of them, is what I am told.

I am not saying that reviewing the medical boards is a bad thing. All service members deserve to have the right to appeals and other second looks.

But adding that administrative paperwork to the plate of physicians already juggling searing personal combat experiences, family disruption, and working non-stop with heavily traumatized patients, may be the straw that breaks the camel’s back.

Administrative reviews also take away from time seeing patients. My colleagues say privately—for they cannot do publically—“I want to treat patients. But I spend all my time on medical boards and other paperwork.”

Best solution set for the paperwork seems to me: hire independent evaluators to do the medical boards, and the reviews of medical boards. Free up the docs to take care of patients. Sounds expensive, but ultimately less costly than not adequately treating Soldiers, who need compassionate care from providers who are not burned out.

There are concrete steps that civilian providers can do:

— Join the TRICARE network, so that you can take care of service members and their families.

— Learn about military culture, so that you can be an effective provider.

— Invite military physicians, nurses, and other providers to give talks at local events, and recognize their sacrifices when you do.

— Work at a military base as a civilian.

— Or consider joining the military yourself.

In whatever capacity, as medical provider or concerned citizens, please support military caregivers. They are spending their lives healing America’s sons and daughters.