Honor. Duty. Sacrifice. Patriotism. If you ask any veteran why they served their nation in either time of peace or war, they are likely to answer with at least one of these words as their primary motivator. An estimated 16.5 million veterans call America their home. While this figure may sound large, U.S. veterans comprise a mere 6.4% of the nation’s adult population. 13 million veterans are in the over 50 years old age demographic (Gilligan, 2022). Hence, interactions between the veteran population and U.S. healthcare infrastructure are frequent.
So, what does a typical U.S. veteran desire in his or her healthcare from those who provide it? I have asked myself this question multiple times throughout my 20-year career in emergency medicine and healthcare leadership. Working on and around major U.S. military installations has afforded me ample opportunities to ask service members from all five services. Surprisingly, with very few exceptions, I receive the same answers time and again.
Trust. Regardless of a veteran’s military occupation or service, the military ethos is built on the fundamental tenant of trust in themselves, among their comrades, within their leadership, and within their nation. Service members ranging from the most elite special operators to the most junior recruit graduate have learned to inculcate trust into the fabric of their lives. It is the bedrock of military culture and the guiding principle behind every military unit.
It should come as no surprise that veterans value trust in their relationships with their medical providers and their healthcare team. Like any other relationship, trust must be earned. It is never simply given. Earning a veteran’s trust involves straightforward communication, demonstration of respect for one’s intelligence, and integration of their wishes and desires into their plan of care or treatment. Most U.S. veterans have been tasked with grave responsibilities, often from a very young age. They are used to making difficult decisions, have respect for time-compressed decision cycles, and understand the need to operate with a sense of urgency. The more involved and literate they are in their own care, the more they will trust their providers.
Dignity. As humans age, our performance, mental agility, and independence often decline. We become more reliant on others to perform tasks or execute activities of daily living. As our bodies begin to fail us, our minds often remember what we were like in our prime. The 75-year-old Vietnam veteran who was once the face of courage and physical toughness now requires help with feeding, bathing, and walking. This can be devastating to those who were viewed as living gods by the men and women they once led and commanded.
Healthcare providers need to be empathetic to the feelings of frustration, shame, and loss of dignity that can accompany a veteran’s decline in physical health. Simple actions such as calling them by their rank (i.e., Sergeant, Chief, Captain, etc.) or encouraging their performance in physical therapy or group exercise can often help restore their dignity. Demonstrating care and concern for their morale and well-being motivates these heroes while giving them a sense of renewed purpose. Unsurprisingly, as their mental attitude improves, their chronic diseases often improve as well.
Humility and Respect. If you go to any Veteran’s Administration clinic, hospital, or long-term care facility, you are bound to run into a war hero or two. Their life stories could easily be the script for a Hollywood production film. Among their personal possessions, you are likely to find some of our nation’s most coveted military medals and decorations, such as the Congressional Medal of Honor, the Navy Cross, or the Silver Star.
As a junior doctor onboard Naval Medical Center Portsmouth (Virginia), I vividly recall my many interactions with Master Diver Carl Brashear, USN. Many know him as the first African American to graduate from the United States Navy’s Diving & Salvage School in 1954. His life and career were later portrayed by Cuba Gooding, Jr in the feature film Men of Honor. I entered residency in June of 2006, and Master Chief Brashear was one of my very first patients. I remember my excitement when I was assigned to his case, having watched the biographical film a few years prior. The ink was barely dry on my medical school diploma, and here I was caring for a celebrity! I remember going to his hospital room to round on him during his admission. I walked in to find a group of Navy Corpsmen huddled around his bed, intently listening to every word he said. I introduced myself and exclaimed it was an honor to care for him. His response floored me; “Son, I’m no different than any other Sailor you are going to see today.”
A few days later, Master Chief Carl Brashear died of heart failure. He was a legend in the United States Navy and attained profound accomplishments under arduous conditions. Despite these accomplishments, I will forever remember how he viewed himself in that hospital bed, a Sailor in the United States Navy. He left an indelible impression on me that continuously reminds me of the importance of humility and humbleness. He, like many other military heroes, do not see themselves as extraordinary or super-human. Rather than boasting about their military service and accolades, they will usually say something very simple like, “I was just doing my job”, or “I was just in the right place at the right time”. They are grateful for the respect and admiration offered to them but prefer to live a peaceful and humble life.
Honesty and Integrity. There is no subpopulation of Americans that demand honesty and integrity from others more than the veteran community. For U.S. servicemembers, there is tremendous value in saying what you mean, and meaning what you say. Unfortunately, every single one of us will eventually die. The date, time, and circumstances of our death are known only to God; however, we can often predict with a fair degree of confidence when it is sooner rather than later. Veterans preparing to make the transition from this life to the next value honest communication regarding their condition and their prognosis. It is common to hear a veteran say, “Just give it to me straight, Doc.” Hence, it is imperative that care providers are up front and honest with veterans when end of life decisions must be made. Candid, clear communication regarding palliative care and terminal disease treatment plans usually increases a veteran’s trust in his or her provider. While it may seem humane to avoid these conversations or skirt around the issue, a refusal to confront these difficult
circumstances only increases anxiety and makes the dying process harder.
Healthcare providers who are privileged and blessed to care for veteran servicemembers are likely to find these interactions the most rewarding of their careers. There is no group of Americans more appreciative or deserving of excellent medical care across the continuum of life. By earning their trust, treating them with dignity and respect, and being honest and candid about their care, you will develop intense bonds with these patients that continue to nurture you personally and professionally long after they cease to be your patients.
Joseph Kotora’s Bio
Joe Kotora is a Captain in the United States Navy Medical Corps and an emergency physician specializing in emergency medical services (EMS) and disaster medicine. He was born and raised in East Brunswick, NJ and attended Stockton University, The University of Medicine and Dentistry of New Jersey, and Rutgers University. He is currently assigned as the Battlefield Medicine subject matter expert to the Pentagon’s Military Warfare Experts Group (MWEG), within the Office of the Undersecretary of Defense-Policy in Arlington, Virginia.