SAN FRANCISCO — Although the Department of Defense conducts a thorough medical screening of each service member returning from a theater of operations, civilian physicians must still be on the lookout for combat-related illnesses, Maj. Robert B. Wenzel, MC, USA, said at the annual meeting of the American Academy of Family Physicians.
Returning service members are so eager to finish the medical screening and be reunited with their families that they often do not focus on the examining physician's questions and concerns, said Dr. Wenzel, commander of the U.S. Army's Butzbach (Germany) Health Clinic.
The initial postdeployment screening is built around a standard DOD form, completed in part by the service member and in part by a DOD physician.
The form collects information on where the individual served and what medical symptoms he or she is experiencing now or experienced during deployment.
Several questions are intended to catch potential cases of posttraumatic stress disorder. For example, service members are asked whether they saw combat, saw people killed, or believed they were in danger of being killed.
After completing their section of the form, service members are seen by a military physician who, by regulation, must spend at least 20 minutes discussing any physical and psychological symptoms. The physician then decides whether to refer a service member to any medical specialists or for any diagnostic procedures.
Service members returning from Afghanistan will receive malaria terminal chemoprophylaxis, typically Plaquenil.
They'll also receive a tuberculin skin test, and anyone who has been deployed for at least 30 days will give a serum sample, which will be stored indefinitely.
“This lesson came out of the Persian Gulf War the first time around, with Gulf War syndrome,” Dr. Wenzel said. “We keep that on file so years from now, when there's a GWOT [Global War on Terror] syndrome, the [DOD] is going to be able to go back, do some research on all these serum samples, and see if we can figure out what's going on.”
Returning service members will also be given a medical briefing which, among other things, will provide them with information about what symptoms of infectious diseases may appear in the coming weeks and months. They are instructed, for example, that if they experience a fever, they shouldn't ignore it; rather, they should see a physician immediately. “There are diseases and bugs and critters in [Iraq and Afghanistan] that modern medicine has forgotten,” he said.
Civilian physicians should ask their patients whether they've recently returned from a combat zone; if so, physicians should consider some uncommon causes of illness (see box), even when the patient presents with seemingly typical flulike symptoms.
Within 90–180 days after returning from deployment, the service member must complete another DOD form that asks about late-appearing symptoms, both physical and psychological.