My medical center recently cemented an agreement with the Veterans Administration to offer care to veterans who could not be accommodated at the VA. We need paying patients, they need doctors of our caliber — establishing mutual benefit. Military veterans have always been among our patients. During my professional lifetime that has included men of my father’s generation whose young adult years encompassed World War II’s widespread draft. World War I and Korea conscriptions were less universal, but patients frequently had served in these settings. Vietnam service seemed more selective.
Even when employed as a VA physician from 1980-88, the patients’ service — while appreciated — was usually parenthetical to their adult medical illnesses. A minority had permanent sequelae of their service, missing limbs, shell-shock or post-traumatic stress disorder depending on which military conflict, a chemical exposure often still in adjudication, intermingling medical care with compensation. Some were more indirect, numerous alcoholics or other substance abusers, maybe some with hypertension, but these were also highly prevalent in people who never served. By age 60 when people started getting admitted to the hospital more frequently, the diseases I treated at the VA seemed to coincide with those encountered elsewhere. They got admitted, I took the best care of them that circumstances would allow for whatever I thought they needed. In the community hospitals and in the office, I shared patients with the VA. And people came by who just happened to have been in the army as young adults but were pretty mainstream after that, going to college, joining a union or seeking jobs as they became available. As prescriptions became more expensive, the VA would often supply medicines to veterans like my father who saw the doctor or nurse practitioner as a precondition for having the prescription supplied but regarded physicians external to the VA as their doctors.
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