Ask the Question: History of "Ask the Question" in New Hampshire

Transcript of video:

One of the ways that health care facilities can be sure to capture important health information from service members and veterans is to take a Military Service Health History. 
To start, a brief military service health history can be taken at intake and included with the packet of forms that all of your clients or patients complete when they come into your facility or practice for care.
The form included in the Toolkit is an example and can be adapted for the needs of your specific service or industry. 
The form asks 6 basic questions but does not request any specific details. 
Those details can come later, during the conversation with the provider. 
An important detail on the military service history that should not be removed when adapting the form to your facilities’ needs is the explanation at the top regarding why we are asking for this information. 
The explanation reads: 
Why are we asking for this information? Military service comes with some unique experiences and exposures, many that civilians would never have. Some of those experiences or exposures might affect your health, now or in the future. Knowing this can help us make sure we are aware of all possible factors when it comes to any health concerns you may have or diagnosis or treatments you may need. 
Keep in mind that some veterans and service members worry that by talking about their service they will be subjected to stereotypes and misunderstanding. 
It is important that the form makes clear why the information is important. 
It is also important to respect an individual’s decision to decline providing the information. 
The Toolkit includes an information sheet that can be given to patients, as well as a script to help providers and staff members answer frequently asked questions about the importance of military health information. 
The Military Service Health History goes on to ask for the branch and dates of service. 
This information is important because certain branches and certain times of service are more likely to encounter certain types of exposures. 
For example, someone who served in the Navy during WWII is much more likely to have been exposed to high amounts of asbestos than someone who served in the Army during the same period. 
Detailed information on such exposures can be found in the Toolkit under Common Military Environmental Exposures. 
The questions go on to ask:
1)    Do you have a service-connected condition or are you rated at the VA for any injures or experiences? 
This information is important for many reasons, but not the least of which is that you as the individual’s provider should be made aware of any conditions your patient may be treated for in other places, or signs and symptoms you should be sensitive to in your exams. A service connected condition or rating could be as complicated as a blood borne illness or as simple as a scar. Some come with disability benefits paid monthly and access to certain services through the VA, while others are simply for documentation purposes in the event some issues arise later. 

2)    Do you receive any of your health care at the VA?
3)    ….

Asking these questions not only provides vital information for the individual’s health care, 

but it also prompts the veteran or service member to think about their military experiences as relevant to their health 

and thus improves the chances that important information will be disclosed. 

The veteran or service member may downplay or minimize his or her answers to some of these questions, 

like “oh sure I was exposed to lots of blasts, but I’m fine!” 

And they might very well be but documenting that exposure in their medical history will be 

important later if symptoms or conditions develop over the course of their life.

So what do you do when the answer to any of these questions is YES? 
The Toolkit provides a step by step worksheet to help guide you and your providers through this process
in a quick and efficient way 
that will allow for important information gathering and rapport building. 

The first 2 steps in the worksheet can be applied by any staff member at any time.
Step 3, 4 and 5 are only necessary when the answers to the previous questions dictate it and are not to be taken lightly. 
These are intended for care and service delivery only and should only be asked in a private, professional setting. 

To start, you will ask the veteran or service member if they mind if you ask them a few health-related questions about their military service... 
Some of the questions will already be answered on the Military Service Heath History form. No need to ask them again, simply follow up on the answers with the associated questions on the worksheet. 

For example, if the individual answered YES to Did you have any illness or Injuries while in the service, simply follow up with the appropriate investigation for details. 
Ask all of the questions in bold. 
When the answer is YES, in the Toolkit there are associated screening tools that can help with diagnosis and treatment planning, 
as well as resources to offer the veteran or service member. 
All yes responses and the relevant details should be recorded in the patient’s problem list in their medical record 
so that all medical encounters and associated providers will have the opportunity to consider the impact of the noted exposures or needs on any presenting concern. 

This information, documented by your facility, might also be an integral part of a veteran or service member’s VA compensation claim, 
whether it be the first documentation of the injury or illness or record of a worsening condition. 
The Toolkit also includes a detailed step by step worksheet that staff and providers can use when talking with a family member of a service member or veteran. 
That worksheet helps to identify and address any care giver issues if relevant- 
or any financial, physical, or emotional difficulties related to their loved-one’s military service 
that they themselves might be experiencing. 
Don’t forget, the family serves too.