Background
Various factors from service in the Australian Defence Force can influence a veteran’s health and wellbeing on transitioning from service. Using available resources to support veterans’ healthcare, such as the VETERANS lens tool, enables general practitioners (GPs) to provide primary care that is sensitive and relevant to a veteran’s experiences.
Objective
This article is aimed at improving awareness of the VETERANS lens tool among GPs and discussing how it can be used to support a comprehensive consultation for veteran patients by providing a structured approach to issues commonly arising from military service.
Discussion
Veteran patients come with a unique background, where their service history, exposures and transitions all play a part in influencing their health and wellbeing, as well as their perception of and access to primary healthcare. The VETERANS lens tool equips GPs to modify their approach to this patient cohort to most effectively optimise health outcomes.
The physical and mental health needs of Australian veterans are often misunderstood or overlooked. Although some veterans do experience long-term health impacts related to their service, many transition into civilian life with valuable skills, resilience and a strong sense of purpose. Veterans are not a homogenous group, and their experiences and health needs vary greatly.
Veterans serve in diverse roles across the Australian Defence Force (ADF). This can make it difficult for general practitioners (GPs) to recognise the health implications of specific service experiences. A new tool, the VETERANS lens,1 has been developed to help GPs understand a veteran’s service history and tailor care in a way that reflects both the risks and the strengths associated with service.
A modern veteran is someone who has completed at least one day of continuous full-time ADF service. Some have deployed to warlike activities during deployment, whereas others have contributed to peacekeeping, humanitarian work or domestic operations.2 Many have trained and worked exclusively in Australia and may not self-identify as veterans. Regardless of their role, military service can involve intense physical training, close team environments, frequent relocations and high expectations.2 These experiences can shape both challenges and strengths in a veteran’s health and wellbeing.
Veterans may face physical health risks related to their work environments, including exposure to dust, loud noise, blast exposure and physical strain, which can contribute to conditions such as hearing loss, osteoarthritis and chronic pain.3 They may also have experienced psychological stressors such as operational pressure, extended separation from family and exposure to trauma.4 These exposures are not universal and should not define the veteran population, but where they do occur, they are best identified through structured, respectful discussion.
Equally important are the protective traits and habits that many veterans develop during service. These include resilience, discipline, teamwork, problem-solving skills and the ability to adapt to challenging circumstances. Many veterans speak positively about their service even when they have faced adversity.3 Recognising and drawing on these strengths during consultations can support recovery and enhance self-agency. For example, veterans who were once highly active may quickly re-establish healthy routines when encouraged.
After discharge, veterans receive healthcare in the community. However, GPs often receive little training about how service history may influence health. To address this gap, the Department of Veterans’ Affairs (DVA) and Medcast have developed a freely available package of health education resources to support GPs.5 This includes accredited webinars, online learning modules and the VETERANS lens – a structured consultation tool designed to help GPs engage with veteran patients in a strengths-based and personalised manner.
All veterans are entitled to support through the DVA, although the level of funded healthcare may vary between individuals. By taking time to understand service experiences, GPs can optimise rehabilitation, treatment and access to supports for their veteran patients to improve lifelong health and wellbeing.
The VETERANS lens offers a practical framework for GPs to identify relevant aspects of military service, understand their clinical implications and strengthen the therapeutic relationship with veteran patients. It helps GPs recognise the relevance of service to health without assuming illness or injury, and it supports more personalised and effective care for veteran patients.
The VETERANS lens was designed for GPs to structure consultations with veterans with the purpose of ensuring that relevant aspects of service are identified during the consultation, and potential impacts of service on ongoing physical and mental health are considered.
Using the VETERANS lens to optimise care
Healthcare is organised and provided for Australians in active service. However, after leaving the ADF, veterans, although at times funded by the DVA, are required to seek healthcare from any provider. Choosing a clinic and GP, accessing Medicare and arranging appointments may be new experiences for the veteran. A GP who considers the impact of the veteran’s service role will facilitate rapport and help ensure that the veteran feels engaged in the consultation process.6 The VETERANS lens (Figure 1) provides structure and guidance in consultations and is useful in assessing new patients as well as existing patients at times of medical decline or new symptomatology.
Veterans’ families may also have been affected by the period of service,4 and using the VETERANS lens when consulting with veteran family members may also ensure potential exposures, difficulties and influencing service history are acknowledged.
Figure 1. The VETERANS lens.1
Reproduced with permission from Medcast.
Values and culture
- Explore experiences within the ADF, including career history and highlights, deployment experiences and discharge history.
Exposure: Ears, eyes and other occupational exposures
- Ask about possible occupational exposures based on role and experiences within the ADF.
- Enquire about hearing and vision.
- Discuss any previous medical illness and injury, including history of concussion(s) and repetitive blast exposure.
Transition
- Consider how transition experience – be it self-directed, medical discharge or transfer to reserves – might be relevant medically, socially and emotionally for this person.
- Take your time in the early stages of the consultation to explore experiences.
- Familiarise yourself with the Veterans’ Health Check, as this will provide the context for you to apply the VETERANS lens and better understand the person before you.
Emotional history: Mental health, wellbeing and connectedness
- Make sure you review mental health periodically.
- Use a screening tool decide if a further mental health history is required; for example:
- Explore interests; find out about activities and hobbies outside of work and home.
- Gauge sense of isolation and feelings of connectedness with a community.
Review of usual medical care including sexual health
- Review past medical history, medication history and current concerns about health.
- Assess sexual health history.
Alcohol and substance use
- Sensitively explore alcohol, smoking or other substance use.
- A screening tool, such as the Alcohol Use Disorders Identification Test – Consumption (AUDIT-C), can be useful.
Navigating the system
- Navigating the civilian health system can be a new experience for ex-ADF members.
- It may be challenging for a veteran to understand exactly how they might use DVA assistance to access healthcare and support, and they will look to you for guidance.
- You may initially find the system of DVA support for veterans to be quite complex from a provider’s perspective.
- Using resources via DVA and the VETs HeLP hub can assist in your understanding of the system.
Supports: Social and resources
- Understanding who is within the veteran’s support network is important. This may include strong bonds with other veterans with whom they have served. Explore any resources for veterans and their families they may have used or are aware of being available.
- Consider what resources are available that you could share with veterans, such as Open Arms or ex-service organisations in your area.
- Consider what internal resources can be used – such as self-discipline, problem solving or resilience.
Conclusion
Veteran patients will have a varied service history, and their experiences within the ADF may have an impact on their physical and mental health. The GP will benefit from having structure and prompts to ensure relevant service experiences are explored in consultations.
The VETERANS lens provides guidance to GPs to enable them to explore relevant service history, exposures and transition impacts, as well as ensure they remember to screen for mental health, alcohol use and substance use disorders.
A good understanding of a veteran’s service history and transition profile will allow the GP to be aware of potential medical issues that may be present or become relevant in the future.
Using the VETERANS lens when first meeting a veteran patient, at appropriate intervals post transition and during times of physical or mental health decline will ensure that the GP is fully aware of potential service impacts on health and that the veteran has optimised healthcare.
Key points
- Veterans’ health and wellbeing can be affected by various factors during service.
- Physical and mental health issues may only become evident years afterwards.
- GPs can optimise care by being aware of the veteran’s service history.
- Using the VETERANS lens ensures relevant aspects of service and veteran- specific supports are explored.
- The VETERANS lens can be used for both initial and subsequent consultations.