Cooperation, Attentiveness Keys to Military Health Success

By John J. Kruzel
American Forces Press Service

Jan. 28, 2008 - Increasing cooperation across the military health community and responding to health care feedback should guide health professionals serving U.S. troops, a top Pentagon official said. During the annual Military Health System conference that kicked off here today, David S. C. Chu, undersecretary of defense for personnel and readiness, spoke to an auditorium packed with servicemember medics and military health personnel.

The public's expectation, appropriately, is that the military health system will deal well with every medical case, Chu said, reminding the crowd that each patient is somebody's son, daughter, father or mother. Far outreaching expectations placed on the private sector, he said, military health care should strive to perform at or above its own elevated standards.

One precept that should steer military health care toward achieving this goal is increasing cooperation among military health personnel, said Chu, who quoted one of the nation's forefathers to illustrate the benefit of working together and the risks of working apart.

"After signing the Declaration of Independence, (Benjamin Franklin's) acid phrase was, 'Gentlemen, either we all hang together, or assuredly, we shall all hang separately,'" Chu said. "Working together, bringing the country together, is one element of future success."

Chu said the Defense and Veterans Affairs departments have adopted a "joint approach" to confronting issues facing the treatment of servicemembers who have suffered significant wounds or injuries during U.S. operations in Iraq and Afghanistan.

The other precept Chu recommended is that personnel listen more closely to concerns raised about military health issues. He noted that two decades ago, the Army conducted seminal research on breast cancer primarily by listening to patients.

In addition to being receptive to patients' feedback, the military health system is listening to the recommendations of external health experts. For instance, the Defense Department has approved nearly every recommendation offered by a bipartisan commission tasked to improve wounded warrior care, Chu said.

Known as the President's Commission on Care for America's Returning Wounded Warriors, the nine-member panel -- co-chaired by Donna Shalala, a former secretary of health and human services, and former Kansas Sen. Bob Dole -- was created in March by President Bush in the wake of news reports that troops at Walter Reed Army Medical Center here were receiving subpar treatment.

In addition to the Dole-Shalala commission, Chu said, key findings have been reported by the Veterans Disability Benefits Commission, the Marsh-West Independent Review Group, the Veterans Affairs Interagency Task Force on Returning Veterans and the Mental Health Task Force. Some of the recommendations help to codify partnerships among various departments; implementing them also will encourage the precept of cooperation, he noted.

Chu said the military health system is tackling key challenges as it rebounds from a year in which the news media -- with varying degrees of accuracy -- raised doubts about military health care.

The CBS television program "60 Minutes" praised the military health system's clinical achievements in a segment highlighting wounded warrior care. But the investigative newsmagazine also questioned "larger personnel" issues, including the system's treatment of veterans and servicemembers suffering from traumatic brain injury, post-traumatic stress disorder and stress related to repeat deployments. The articles about Walter Reed that appeared in the Washington Post in February exposed similar shortcomings in long-term care.

Further, an article in the New York Times questioned whether the military health community paid sufficient attention to the effects of war on servicemembers, suggesting that violent behavior patterns in veterans might be rooted in combat experience. Chu noted the report's veracity was later questioned by an editor at the paper.

"Nonetheless, all these questions, I argue, remind us that we're responsible for every case that we care for, from the beginning to end, as these individuals resume their military careers or move to civil life," Chu said. "In short, a good clinical outcome is not enough. The whole personnel outcome is really the issue with which we must deal."

To amplify the level of feedback from servicemembers, Chu said military health patients are surveyed on how satisfied they are with health care they receive. Results of surveys completed by patients and family members will be considered by the military health community, Chu said.

"We are not simply aiming at an absence of complaints in these surveys," Chu said, "but on whether most, if not all, feel good about the experience they've had accepting that many of the wounds are grievous and that there will be life-changing outcomes as a result of these events."

Chu said the military health system has recently succeeded by adapting to meet challenges. A decade ago, he said, military personnel were not responsible for bringing servicemembers injured in combat back to the United States. Now, however, it is virtually taken for granted that servicemembers arrive home in some cases within 36 hours of their injury.

"We can do it if we listen; we can do it if we work together," Chu said about continuing military health success. "I hope at next year's conference, as we look back on what's happened in 2008, that we can conclude that Ben Franklin would have indeed been proud of us."