Cynthia M.A. Geppert, MD

Some of you who are reading this column likely are military brats from one branch or another. Many of us felt the call to give back by either joining the military, PHS, or working in organizations like the VA, treating former service members. That certainly was a huge motivation for me to become a VA physician. I always felt more welcomed, even felt at home, at the VA or at a military hospital than I did at any civilian health care facility. And many of my colleagues feel the same way. Other brats have never interacted much with the military except for their being raised by family members in the armed forces; yet this designation is still a part of their identity, one that is especially important as the number of Americans with a military connection continues to decline.

The percentage of adults > 50 years old who have an immediate family member who served in the military is 77%; the percentage of those aged 30 to 49 years is 57%; and aged < 30 years, only 33%.¹ Almost 5% of adult Americans are military brats. This demographic trend brings with it an increasing chance that current and former service members may feel socially isolated and that many health care professionals will struggle to relate to, and appreciate, their unique cultural background.

Authors always should acknowledge any material conflict of interest, and as a double Army brat, I am far from objective on this subject. I was born and raised on an army base. My father was a career military physician, and my mother, albeit briefly, was an army nurse. Some of my earliest memories are of being with my father and driving around Fort Sam Houston when everyone and everything stopped upon hearing the sound of a bugle (at the time, it was still a real bugle). My father and I would get out of the car. He would salute, and I would stand as still as a small active child can while we turned toward the flag being lowered over the base.

In reading about army brats, this memory seems to be a common one. Many individuals have commented on how this repeated experience from their youth instilled in them a sense of respect for our flag and country and an appreciation of order and discipline that stayed with them long after they became adults.

Obviously, while those of us claiming this identity use it positively as a phrase of winsome nostalgia and civic pride, in everyday language a brat is a pejorative reference. The online magazine Military Brat Life, defines the term as “someone, who, as a child, grows up in a family where one or more parents are ‘career’ military, and where the children move from base to base, experiencing life in several different places and possibly different countries.”² The phrase denotes an individual whose parents at some point served full-time in the military, no duration is specified or whether the parents had to be active duty, reserve or National Guard members. The prefix for the label comes from the military branch in which the parents primarily served, though like hyphenated names some younger generations will introduce themselves as a Navy-Air Force brat. Other sites suggest that it doesn’t refer to a spoiled child at all but actually is yet another of the acronyms that proliferate in military environments. Although after I read these possible theories, many seemed retrospective attempts to jettison the negative connotations.

I learned that like others sharing similar formative experiences, military brats are considered a subculture or a third culture, in some of the literature. There is a dearth of scholarly data about the phenomenology and social psychology of adults who spent some of their formative years under the auspices of military culture. As in any foray into cultural competence, avoiding stereotypes is crucial. However, research has shown that the experience of growing up in the military is one that bestows resilience and risk.³ It is also an important piece of a patient’s narrative that health care professionals in and out of the federal system should consider to provide patient-centered care.

A childhood in a military environment is often romanticized as shaping an adult who is worldly, cosmopolitan, resilient, and tolerant. Although these are adaptive traits that children of military personnel develop, there also is a far darker side emerging in the research.⁴ We are all too aware of the epidemic of suicide, opioid use, and posttraumatic stress disorder that has developed in the wake of our country’s latest and lasting conflicts. The reverberations of these mental health problems are felt by the children who lived through them or who lost loved ones to war or suicide. The DoD has begun recognizing this collateral damage and is developing innovative programs to help children and adolescents.

We need to do more though, not just in this arena when the wounds occur, but also later when those wounded come to nurse practitioners and psychologists, social workers, and physicians. Our growing number of community partners through Choice and other programs also need to be aware of the potential mental health impacts of being a military brat or family member.

In the introduction to one of the best books written on the subject, Military Brats: Legacies of Childhood Inside the Fortress, author Pat Conroy wrote, “I thought I was singular in all this, one of a kind.... I discovered that I speak in the multitongued, deep-throated voice of my tribe. It’s a language I was not even aware I spoke... a secret family I did not know I had.... Military brats, my lost tribe, spent their entire youth in service to this country, and no one even knew we were there.”⁵

Some of you who are reading this column likely are military brats from one branch or another. Many of us felt the call to give back by either joining the military, PHS, or working in organizations like the VA, treating former service members. That certainly was a huge motivation for me to become a VA physician. I always felt more welcomed, even felt at home, at the VA or at a military hospital than I did at any civilian health care facility. And many of my colleagues feel the same way. Other brats have never interacted much with the military except for their being raised by family members in the armed forces; yet this designation is still a part of their identity, one that is especially important as the number of Americans with a military connection continues to decline.

The percentage of adults > 50 years old who have an immediate family member who served in the military is 77%; the percentage of those aged 30 to 49 years is 57%; and aged < 30 years, only 33%.¹ Almost 5% of adult Americans are military brats. This demographic trend brings with it an increasing chance that current and former service members may feel socially isolated and that many health care professionals will struggle to relate to, and appreciate, their unique cultural background.

Authors always should acknowledge any material conflict of interest, and as a double Army brat, I am far from objective on this subject. I was born and raised on an army base. My father was a career military physician, and my mother, albeit briefly, was an army nurse. Some of my earliest memories are of being with my father and driving around Fort Sam Houston when everyone and everything stopped upon hearing the sound of a bugle (at the time, it was still a real bugle). My father and I would get out of the car. He would salute, and I would stand as still as a small active child can while we turned toward the flag being lowered over the base.

In reading about army brats, this memory seems to be a common one. Many individuals have commented on how this repeated experience from their youth instilled in them a sense of respect for our flag and country and an appreciation of order and discipline that stayed with them long after they became adults.

Obviously, while those of us claiming this identity use it positively as a phrase of winsome nostalgia and civic pride, in everyday language a brat is a pejorative reference. The online magazine Military Brat Life, defines the term as “someone, who, as a child, grows up in a family where one or more parents are ‘career’ military, and where the children move from base to base, experiencing life in several different places and possibly different countries.”² The phrase denotes an individual whose parents at some point served full-time in the military, no duration is specified or whether the parents had to be active duty, reserve or National Guard members. The prefix for the label comes from the military branch in which the parents primarily served, though like hyphenated names some younger generations will introduce themselves as a Navy-Air Force brat. Other sites suggest that it doesn’t refer to a spoiled child at all but actually is yet another of the acronyms that proliferate in military environments. Although after I read these possible theories, many seemed retrospective attempts to jettison the negative connotations.

I learned that like others sharing similar formative experiences, military brats are considered a subculture or a third culture, in some of the literature. There is a dearth of scholarly data about the phenomenology and social psychology of adults who spent some of their formative years under the auspices of military culture. As in any foray into cultural competence, avoiding stereotypes is crucial. However, research has shown that the experience of growing up in the military is one that bestows resilience and risk.³ It is also an important piece of a patient’s narrative that health care professionals in and out of the federal system should consider to provide patient-centered care.

A childhood in a military environment is often romanticized as shaping an adult who is worldly, cosmopolitan, resilient, and tolerant. Although these are adaptive traits that children of military personnel develop, there also is a far darker side emerging in the research.⁴ We are all too aware of the epidemic of suicide, opioid use, and posttraumatic stress disorder that has developed in the wake of our country’s latest and lasting conflicts. The reverberations of these mental health problems are felt by the children who lived through them or who lost loved ones to war or suicide. The DoD has begun recognizing this collateral damage and is developing innovative programs to help children and adolescents.

We need to do more though, not just in this arena when the wounds occur, but also later when those wounded come to nurse practitioners and psychologists, social workers, and physicians. Our growing number of community partners through Choice and other programs also need to be aware of the potential mental health impacts of being a military brat or family member.

In the introduction to one of the best books written on the subject, Military Brats: Legacies of Childhood Inside the Fortress, author Pat Conroy wrote, “I thought I was singular in all this, one of a kind.... I discovered that I speak in the multitongued, deep-throated voice of my tribe. It’s a language I was not even aware I spoke... a secret family I did not know I had.... Military brats, my lost tribe, spent their entire youth in service to this country, and no one even knew we were there.”⁵

Some of you who are reading this column likely are military brats from one branch or another. Many of us felt the call to give back by either joining the military, PHS, or working in organizations like the VA, treating former service members. That certainly was a huge motivation for me to become a VA physician. I always felt more welcomed, even felt at home, at the VA or at a military hospital than I did at any civilian health care facility. And many of my colleagues feel the same way. Other brats have never interacted much with the military except for their being raised by family members in the armed forces; yet this designation is still a part of their identity, one that is especially important as the number of Americans with a military connection continues to decline.

The percentage of adults > 50 years old who have an immediate family member who served in the military is 77%; the percentage of those aged 30 to 49 years is 57%; and aged < 30 years, only 33%.¹ Almost 5% of adult Americans are military brats. This demographic trend brings with it an increasing chance that current and former service members may feel socially isolated and that many health care professionals will struggle to relate to, and appreciate, their unique cultural background.

Authors always should acknowledge any material conflict of interest, and as a double Army brat, I am far from objective on this subject. I was born and raised on an army base. My father was a career military physician, and my mother, albeit briefly, was an army nurse. Some of my earliest memories are of being with my father and driving around Fort Sam Houston when everyone and everything stopped upon hearing the sound of a bugle (at the time, it was still a real bugle). My father and I would get out of the car. He would salute, and I would stand as still as a small active child can while we turned toward the flag being lowered over the base.

In reading about army brats, this memory seems to be a common one. Many individuals have commented on how this repeated experience from their youth instilled in them a sense of respect for our flag and country and an appreciation of order and discipline that stayed with them long after they became adults.

Obviously, while those of us claiming this identity use it positively as a phrase of winsome nostalgia and civic pride, in everyday language a brat is a pejorative reference. The online magazine Military Brat Life, defines the term as “someone, who, as a child, grows up in a family where one or more parents are ‘career’ military, and where the children move from base to base, experiencing life in several different places and possibly different countries.”² The phrase denotes an individual whose parents at some point served full-time in the military, no duration is specified or whether the parents had to be active duty, reserve or National Guard members. The prefix for the label comes from the military branch in which the parents primarily served, though like hyphenated names some younger generations will introduce themselves as a Navy-Air Force brat. Other sites suggest that it doesn’t refer to a spoiled child at all but actually is yet another of the acronyms that proliferate in military environments. Although after I read these possible theories, many seemed retrospective attempts to jettison the negative connotations.

I learned that like others sharing similar formative experiences, military brats are considered a subculture or a third culture, in some of the literature. There is a dearth of scholarly data about the phenomenology and social psychology of adults who spent some of their formative years under the auspices of military culture. As in any foray into cultural competence, avoiding stereotypes is crucial. However, research has shown that the experience of growing up in the military is one that bestows resilience and risk.³ It is also an important piece of a patient’s narrative that health care professionals in and out of the federal system should consider to provide patient-centered care.

A childhood in a military environment is often romanticized as shaping an adult who is worldly, cosmopolitan, resilient, and tolerant. Although these are adaptive traits that children of military personnel develop, there also is a far darker side emerging in the research.⁴ We are all too aware of the epidemic of suicide, opioid use, and posttraumatic stress disorder that has developed in the wake of our country’s latest and lasting conflicts. The reverberations of these mental health problems are felt by the children who lived through them or who lost loved ones to war or suicide. The DoD has begun recognizing this collateral damage and is developing innovative programs to help children and adolescents.

We need to do more though, not just in this arena when the wounds occur, but also later when those wounded come to nurse practitioners and psychologists, social workers, and physicians. Our growing number of community partners through Choice and other programs also need to be aware of the potential mental health impacts of being a military brat or family member.

In the introduction to one of the best books written on the subject, Military Brats: Legacies of Childhood Inside the Fortress, author Pat Conroy wrote, “I thought I was singular in all this, one of a kind.... I discovered that I speak in the multitongued, deep-throated voice of my tribe. It’s a language I was not even aware I spoke... a secret family I did not know I had.... Military brats, my lost tribe, spent their entire youth in service to this country, and no one even knew we were there.”⁵

During his testimony before the House Committee on Veterans Affairs on March 7, 2017, Secretary of Veterans Affairs David J. Shulkin, MD, expressed his intent to remove the administrative barrier prohibiting other-than-honorably (OTH) discharged service members from receiving VHA mental health care. This is the first time in VA history to integrate those veterans whose OTH discharge status had previously disenfranchised them.

In his comments to Congress, Dr. Shulkin voiced his gratitude to Rep. Mike Coffman (R-CO) for helping him to “better understand the urgency of getting this right.” In March 2016, Rep. Coffman introduced the

Veterans Fairness Act, which would permit OTH discharged combat veterans to obtain emergency mental health services. Rep. Coffman cited that 22,000 U.S. Army veterans were discharged for misconduct since 2009, most with a traumatic brain injury (TBI) or mental illness.¹ Veterans often refer to OTH discharges as having “bad paper.” In 2013, National Public Radio produced a series on OTH discharged service members that underscored their struggles.² Those reports estimated that more than 100,000 veterans left the service with OTH discharges in the decade before the story.²

These individuals, many of whom have already lost a great deal as a result of their military service, lose much more when they are OTH discharged. They are unable to apply for the GI Bill, which enables them to further their education and livelihood; they cannot get a VA home loan to help them house their families; and they are ineligible for disability even for combat-related conditions like posttraumatic stress disorder (PTSD) and TBI. Most damaging of all, until Dr. Shulkin’s historic announcement, they also could not get VA health care. In effect, OTH discharge status creates a second class of service men and women, even though the discharge may have been the result of injury and illness related to their time in uniform. That consequence makes Dr. Shulkin’s proposal not only an administrative change, but also an ethical decision regarding the civil and human rights of service members, which is the reason most major veterans service and advocacy organizations have long endorsed it.

Although research on OTH discharged veterans has been limited, studies have found a high rate of mental health problems. The OTH discharged service members are significantly represented in the cohorts who face some of the most serious public health problems that the VA has tried to address through new programs that were initiated during the prior administration and continued by the current one, such as ending homelessness and preventing suicide.

A 2017 study compared rates of mental illness and substance use among veterans with routine discharges with those who had nonroutine separations from the military.³ The results showed that there was a higher rate of almost every psychiatric diagnosis in the nonroutine discharges; the rates were particularly high for those discharged for misconduct.³ Because of the established correlation of multiple deployments to Afghanistan and Iraq and incidence of TBI, PTSD, and substance use and the association of these disorders with behaviors that contribute to OTH discharge status, a clear duty to care for these men and women emerges.

Similarly, the ethical principle of nonmalfeasance provides persuasive justification for Dr. Shulkin’s proposed change in VA eligibility for mental health care. The study also found that even if not previously entitled to VA services, these veterans share the increased risk of suicide found in all those who have worn a uniform for their country and similarly need compassionate, competent veteran-centered care.³

Recent research showed that patients who receive mental health care within the VA have lower rates of suicide than that of those who receive care in the community.⁴ The results of this study contribute to the ethical imperative to grant these former service members access to potentially life-saving mental health treatment more urgent.

The elevated suicide risk of those veterans who do not have VA mental health services makes this extension of care clinically and ethically imperative and urgent. In his testimony at the hearing, Dr. Shulkin underscored this rationale, “The President and I have made it clear that suicide prevention is one of our top priorities,” Shulkin added. “We know the rate of death by suicide among veterans who do not use VA care is increasing at a greater rate than veterans who use VA care. This is a national emergency that requires bold action. We must and we will do all that we can to help former service members who may be at risk. When we say even one veteran suicide is one too many, we mean it.

The downstream consequences of OTH discharge status are the most detrimental to the veteran and have negative effects on the veteran’s family and community. Nonroutinely discharged veterans are more likely to be homeless. The new initiative would open a variety of VA mental health services to OTH discharged service members, including those available in VA emergency departments, Vet Centers, and the Veterans Crisis Line. In developing the plan to expand coverage to OTH discharged veterans, Dr. Shulkin indicated that he would consult with Veterans Service Organizations and the DoD.

We can hope that additional services will be opened to OTH discharged service members, such as case management and housing assistance, which have proven so successful in reintegrating those service members with routine discharges.

During his testimony before the House Committee on Veterans Affairs on March 7, 2017, Secretary of Veterans Affairs David J. Shulkin, MD, expressed his intent to remove the administrative barrier prohibiting other-than-honorably (OTH) discharged service members from receiving VHA mental health care. This is the first time in VA history to integrate those veterans whose OTH discharge status had previously disenfranchised them.

In his comments to Congress, Dr. Shulkin voiced his gratitude to Rep. Mike Coffman (R-CO) for helping him to “better understand the urgency of getting this right.” In March 2016, Rep. Coffman introduced the

Veterans Fairness Act, which would permit OTH discharged combat veterans to obtain emergency mental health services. Rep. Coffman cited that 22,000 U.S. Army veterans were discharged for misconduct since 2009, most with a traumatic brain injury (TBI) or mental illness.¹ Veterans often refer to OTH discharges as having “bad paper.” In 2013, National Public Radio produced a series on OTH discharged service members that underscored their struggles.² Those reports estimated that more than 100,000 veterans left the service with OTH discharges in the decade before the story.²

These individuals, many of whom have already lost a great deal as a result of their military service, lose much more when they are OTH discharged. They are unable to apply for the GI Bill, which enables them to further their education and livelihood; they cannot get a VA home loan to help them house their families; and they are ineligible for disability even for combat-related conditions like posttraumatic stress disorder (PTSD) and TBI. Most damaging of all, until Dr. Shulkin’s historic announcement, they also could not get VA health care. In effect, OTH discharge status creates a second class of service men and women, even though the discharge may have been the result of injury and illness related to their time in uniform. That consequence makes Dr. Shulkin’s proposal not only an administrative change, but also an ethical decision regarding the civil and human rights of service members, which is the reason most major veterans service and advocacy organizations have long endorsed it.

Although research on OTH discharged veterans has been limited, studies have found a high rate of mental health problems. The OTH discharged service members are significantly represented in the cohorts who face some of the most serious public health problems that the VA has tried to address through new programs that were initiated during the prior administration and continued by the current one, such as ending homelessness and preventing suicide.

A 2017 study compared rates of mental illness and substance use among veterans with routine discharges with those who had nonroutine separations from the military.³ The results showed that there was a higher rate of almost every psychiatric diagnosis in the nonroutine discharges; the rates were particularly high for those discharged for misconduct.³ Because of the established correlation of multiple deployments to Afghanistan and Iraq and incidence of TBI, PTSD, and substance use and the association of these disorders with behaviors that contribute to OTH discharge status, a clear duty to care for these men and women emerges.

Similarly, the ethical principle of nonmalfeasance provides persuasive justification for Dr. Shulkin’s proposed change in VA eligibility for mental health care. The study also found that even if not previously entitled to VA services, these veterans share the increased risk of suicide found in all those who have worn a uniform for their country and similarly need compassionate, competent veteran-centered care.³

Recent research showed that patients who receive mental health care within the VA have lower rates of suicide than that of those who receive care in the community.⁴ The results of this study contribute to the ethical imperative to grant these former service members access to potentially life-saving mental health treatment more urgent.

The elevated suicide risk of those veterans who do not have VA mental health services makes this extension of care clinically and ethically imperative and urgent. In his testimony at the hearing, Dr. Shulkin underscored this rationale, “The President and I have made it clear that suicide prevention is one of our top priorities,” Shulkin added. “We know the rate of death by suicide among veterans who do not use VA care is increasing at a greater rate than veterans who use VA care. This is a national emergency that requires bold action. We must and we will do all that we can to help former service members who may be at risk. When we say even one veteran suicide is one too many, we mean it.

The downstream consequences of OTH discharge status are the most detrimental to the veteran and have negative effects on the veteran’s family and community. Nonroutinely discharged veterans are more likely to be homeless. The new initiative would open a variety of VA mental health services to OTH discharged service members, including those available in VA emergency departments, Vet Centers, and the Veterans Crisis Line. In developing the plan to expand coverage to OTH discharged veterans, Dr. Shulkin indicated that he would consult with Veterans Service Organizations and the DoD.

We can hope that additional services will be opened to OTH discharged service members, such as case management and housing assistance, which have proven so successful in reintegrating those service members with routine discharges.

During his testimony before the House Committee on Veterans Affairs on March 7, 2017, Secretary of Veterans Affairs David J. Shulkin, MD, expressed his intent to remove the administrative barrier prohibiting other-than-honorably (OTH) discharged service members from receiving VHA mental health care. This is the first time in VA history to integrate those veterans whose OTH discharge status had previously disenfranchised them.

In his comments to Congress, Dr. Shulkin voiced his gratitude to Rep. Mike Coffman (R-CO) for helping him to “better understand the urgency of getting this right.” In March 2016, Rep. Coffman introduced the

Veterans Fairness Act, which would permit OTH discharged combat veterans to obtain emergency mental health services. Rep. Coffman cited that 22,000 U.S. Army veterans were discharged for misconduct since 2009, most with a traumatic brain injury (TBI) or mental illness.¹ Veterans often refer to OTH discharges as having “bad paper.” In 2013, National Public Radio produced a series on OTH discharged service members that underscored their struggles.² Those reports estimated that more than 100,000 veterans left the service with OTH discharges in the decade before the story.²

These individuals, many of whom have already lost a great deal as a result of their military service, lose much more when they are OTH discharged. They are unable to apply for the GI Bill, which enables them to further their education and livelihood; they cannot get a VA home loan to help them house their families; and they are ineligible for disability even for combat-related conditions like posttraumatic stress disorder (PTSD) and TBI. Most damaging of all, until Dr. Shulkin’s historic announcement, they also could not get VA health care. In effect, OTH discharge status creates a second class of service men and women, even though the discharge may have been the result of injury and illness related to their time in uniform. That consequence makes Dr. Shulkin’s proposal not only an administrative change, but also an ethical decision regarding the civil and human rights of service members, which is the reason most major veterans service and advocacy organizations have long endorsed it.

Although research on OTH discharged veterans has been limited, studies have found a high rate of mental health problems. The OTH discharged service members are significantly represented in the cohorts who face some of the most serious public health problems that the VA has tried to address through new programs that were initiated during the prior administration and continued by the current one, such as ending homelessness and preventing suicide.

A 2017 study compared rates of mental illness and substance use among veterans with routine discharges with those who had nonroutine separations from the military.³ The results showed that there was a higher rate of almost every psychiatric diagnosis in the nonroutine discharges; the rates were particularly high for those discharged for misconduct.³ Because of the established correlation of multiple deployments to Afghanistan and Iraq and incidence of TBI, PTSD, and substance use and the association of these disorders with behaviors that contribute to OTH discharge status, a clear duty to care for these men and women emerges.

Similarly, the ethical principle of nonmalfeasance provides persuasive justification for Dr. Shulkin’s proposed change in VA eligibility for mental health care. The study also found that even if not previously entitled to VA services, these veterans share the increased risk of suicide found in all those who have worn a uniform for their country and similarly need compassionate, competent veteran-centered care.³

Recent research showed that patients who receive mental health care within the VA have lower rates of suicide than that of those who receive care in the community.⁴ The results of this study contribute to the ethical imperative to grant these former service members access to potentially life-saving mental health treatment more urgent.

The elevated suicide risk of those veterans who do not have VA mental health services makes this extension of care clinically and ethically imperative and urgent. In his testimony at the hearing, Dr. Shulkin underscored this rationale, “The President and I have made it clear that suicide prevention is one of our top priorities,” Shulkin added. “We know the rate of death by suicide among veterans who do not use VA care is increasing at a greater rate than veterans who use VA care. This is a national emergency that requires bold action. We must and we will do all that we can to help former service members who may be at risk. When we say even one veteran suicide is one too many, we mean it.

The downstream consequences of OTH discharge status are the most detrimental to the veteran and have negative effects on the veteran’s family and community. Nonroutinely discharged veterans are more likely to be homeless. The new initiative would open a variety of VA mental health services to OTH discharged service members, including those available in VA emergency departments, Vet Centers, and the Veterans Crisis Line. In developing the plan to expand coverage to OTH discharged veterans, Dr. Shulkin indicated that he would consult with Veterans Service Organizations and the DoD.

We can hope that additional services will be opened to OTH discharged service members, such as case management and housing assistance, which have proven so successful in reintegrating those service members with routine discharges.

In many parts of the country, spring is finally emerging from the long, hard, cold winter. In almost every culture, spring is associated with rebirth, the return of longer daylight hours, growth, and new life. Like seeds planted in the fall, many of the ideas we at Federal Practitioner sowed in 2016 are now blossoming—our new Historic Profiles and Mental Health Care Practice columns, among others. Just as many of us are engaging in spring cleaning in our homes and yards and opening windows to let in the warmth and the breezes, we at the journal are making room for inspiration and illumination—yours.

Our internal reorganization has enabled us to focus on what we enjoy most—publishing your work. We invite each of you to consider submitting a manuscript and encouraging your colleagues to do so. Almost every health care professional at some time in his or her career has thought of a study to write, read an article they wished they had written, or reviewed a topic they thought suitable for publication. Well, it is time to dust off those ideas and pull them out of the drawer or computer file, just like getting out the warm weather clothing.

In order to reflect the positive trend in federal health care toward multi- and interdisciplinary teams and practice, we welcome submissions from all our clinical constituents, including physicians, surgeons, chaplains, nurses, clinical pharmacists, advanced practice nurses, psychologists, physician assistants, administrators, allied health professionals, and any and all that my old brain cannot recall.

There is nothing like the feeling of seeing your work published in print or on the Internet for the first time in an esteemed journal. If you are a teacher or mentor, think about the gift of inviting a trainee or junior colleague to coauthor an article. This collaboration can be a wonderful shared creative endeavor for educators and their students.

If you have a good idea but are concerned that your writing may be too rough, we invite you to take a leap of faith. Although as a peer-reviewed journal we cannot guarantee acceptance of any manuscript, we can assure you that our editorial staff has smoothed more than a few bumps in our authors’ literary endeavors.

Federal Practitioner is a peer-reviewed journal that has a wide audience among federal health care professionals in the DoD, VA, and PHS. We at the journal are working to become indexed in PubMed, which will provide potential authors with an even wider and more prestigious exposure for their work. We invite you to visit our website and review this print journal to get an idea—if you don’t already have one—of the types of articles we publish. To jump-start your motivation, here is a brief description of the many types of articles we accept.

Feature Articles

Feature articles may be original research or comprehensive summaries of a clinically related topic. The possibilities are as endless as federal practice and could cover medications, other types of interventions (including psychosocial treatments), and reviews of diagnoses.

Original Research

We welcome empirical studies of completed research both biomedical and biobehavioral. More experienced and senior researchers might consider that publication in Federal Practitioner potentially can demonstrate their commitment to conducting research that benefits the members of the armed forces, public services, and veterans, to government funding agencies, increasingly a requirement for grants from those institutions. And for junior or new researchers, we offer a new option to publish pilot studies for research that is just getting launched or is on a smaller scale.

Case Reports

What health care professional has not had a case so memorable that he or she cannot forget it, or a patient encounter that made a lasting impression, or one in which they gained valuable medical knowledge or human wisdom? Ever thought of writing it up for your peers to learn from as well? Submit a case to Federal Practitioner and share your clinical pearls with your colleagues. The authoring process also gives you a chance to review the latest clinical literature on a diagnosis or treatment you wanted to know more about.

Program Profiles

This section of the journal reflects the unparalleled scope and resources of federal health care. Whether it is a national initiative or a local experiment, we want to know and let others read about the beneficial work that you are doing to care for service members, veterans, and the public. Submissions can be of innovative clinical or research projects or programs.

Guest Editorials

While usually members of the Editorial Advisory Association author guest editorials, we are pleased to consider high-quality, thought provoking editorials on themes of health care policy, organization, care delivery, ethics, and professionalism, among others.

Most of us have made the painful adjustment to daylight savings time. Use those extra hours of daylight to stimulate your creative brain. If writing a manuscript does not fit in to your busy schedule right now, think about becoming a peer reviewer or even a member of the Editorial Advisory Association. And last but not least, we are a friendly and open editorial team that is willing to entertain an imaginative suggestion for a manuscript that is novel and vital just like spring.

The Federal Practitioner submission guidelines, accessed at http://www.fedprac.com, include the journal’s style and format. If you need more information or have questions about submitting a manuscript to the journal, e-mail me at [email protected], Editor Reid Paul at [email protected],or Managing Editor Joyce Brody at [email protected].

In many parts of the country, spring is finally emerging from the long, hard, cold winter. In almost every culture, spring is associated with rebirth, the return of longer daylight hours, growth, and new life. Like seeds planted in the fall, many of the ideas we at Federal Practitioner sowed in 2016 are now blossoming—our new Historic Profiles and Mental Health Care Practice columns, among others. Just as many of us are engaging in spring cleaning in our homes and yards and opening windows to let in the warmth and the breezes, we at the journal are making room for inspiration and illumination—yours.

Our internal reorganization has enabled us to focus on what we enjoy most—publishing your work. We invite each of you to consider submitting a manuscript and encouraging your colleagues to do so. Almost every health care professional at some time in his or her career has thought of a study to write, read an article they wished they had written, or reviewed a topic they thought suitable for publication. Well, it is time to dust off those ideas and pull them out of the drawer or computer file, just like getting out the warm weather clothing.

In order to reflect the positive trend in federal health care toward multi- and interdisciplinary teams and practice, we welcome submissions from all our clinical constituents, including physicians, surgeons, chaplains, nurses, clinical pharmacists, advanced practice nurses, psychologists, physician assistants, administrators, allied health professionals, and any and all that my old brain cannot recall.

There is nothing like the feeling of seeing your work published in print or on the Internet for the first time in an esteemed journal. If you are a teacher or mentor, think about the gift of inviting a trainee or junior colleague to coauthor an article. This collaboration can be a wonderful shared creative endeavor for educators and their students.

If you have a good idea but are concerned that your writing may be too rough, we invite you to take a leap of faith. Although as a peer-reviewed journal we cannot guarantee acceptance of any manuscript, we can assure you that our editorial staff has smoothed more than a few bumps in our authors’ literary endeavors.

Federal Practitioner is a peer-reviewed journal that has a wide audience among federal health care professionals in the DoD, VA, and PHS. We at the journal are working to become indexed in PubMed, which will provide potential authors with an even wider and more prestigious exposure for their work. We invite you to visit our website and review this print journal to get an idea—if you don’t already have one—of the types of articles we publish. To jump-start your motivation, here is a brief description of the many types of articles we accept.

Feature Articles

Feature articles may be original research or comprehensive summaries of a clinically related topic. The possibilities are as endless as federal practice and could cover medications, other types of interventions (including psychosocial treatments), and reviews of diagnoses.

Original Research

We welcome empirical studies of completed research both biomedical and biobehavioral. More experienced and senior researchers might consider that publication in Federal Practitioner potentially can demonstrate their commitment to conducting research that benefits the members of the armed forces, public services, and veterans, to government funding agencies, increasingly a requirement for grants from those institutions. And for junior or new researchers, we offer a new option to publish pilot studies for research that is just getting launched or is on a smaller scale.

Case Reports

What health care professional has not had a case so memorable that he or she cannot forget it, or a patient encounter that made a lasting impression, or one in which they gained valuable medical knowledge or human wisdom? Ever thought of writing it up for your peers to learn from as well? Submit a case to Federal Practitioner and share your clinical pearls with your colleagues. The authoring process also gives you a chance to review the latest clinical literature on a diagnosis or treatment you wanted to know more about.

Program Profiles

This section of the journal reflects the unparalleled scope and resources of federal health care. Whether it is a national initiative or a local experiment, we want to know and let others read about the beneficial work that you are doing to care for service members, veterans, and the public. Submissions can be of innovative clinical or research projects or programs.

Guest Editorials

While usually members of the Editorial Advisory Association author guest editorials, we are pleased to consider high-quality, thought provoking editorials on themes of health care policy, organization, care delivery, ethics, and professionalism, among others.

Most of us have made the painful adjustment to daylight savings time. Use those extra hours of daylight to stimulate your creative brain. If writing a manuscript does not fit in to your busy schedule right now, think about becoming a peer reviewer or even a member of the Editorial Advisory Association. And last but not least, we are a friendly and open editorial team that is willing to entertain an imaginative suggestion for a manuscript that is novel and vital just like spring.

The Federal Practitioner submission guidelines, accessed at http://www.fedprac.com, include the journal’s style and format. If you need more information or have questions about submitting a manuscript to the journal, e-mail me at [email protected], Editor Reid Paul at [email protected],or Managing Editor Joyce Brody at [email protected].

In many parts of the country, spring is finally emerging from the long, hard, cold winter. In almost every culture, spring is associated with rebirth, the return of longer daylight hours, growth, and new life. Like seeds planted in the fall, many of the ideas we at Federal Practitioner sowed in 2016 are now blossoming—our new Historic Profiles and Mental Health Care Practice columns, among others. Just as many of us are engaging in spring cleaning in our homes and yards and opening windows to let in the warmth and the breezes, we at the journal are making room for inspiration and illumination—yours.

Our internal reorganization has enabled us to focus on what we enjoy most—publishing your work. We invite each of you to consider submitting a manuscript and encouraging your colleagues to do so. Almost every health care professional at some time in his or her career has thought of a study to write, read an article they wished they had written, or reviewed a topic they thought suitable for publication. Well, it is time to dust off those ideas and pull them out of the drawer or computer file, just like getting out the warm weather clothing.

In order to reflect the positive trend in federal health care toward multi- and interdisciplinary teams and practice, we welcome submissions from all our clinical constituents, including physicians, surgeons, chaplains, nurses, clinical pharmacists, advanced practice nurses, psychologists, physician assistants, administrators, allied health professionals, and any and all that my old brain cannot recall.

There is nothing like the feeling of seeing your work published in print or on the Internet for the first time in an esteemed journal. If you are a teacher or mentor, think about the gift of inviting a trainee or junior colleague to coauthor an article. This collaboration can be a wonderful shared creative endeavor for educators and their students.

If you have a good idea but are concerned that your writing may be too rough, we invite you to take a leap of faith. Although as a peer-reviewed journal we cannot guarantee acceptance of any manuscript, we can assure you that our editorial staff has smoothed more than a few bumps in our authors’ literary endeavors.

Federal Practitioner is a peer-reviewed journal that has a wide audience among federal health care professionals in the DoD, VA, and PHS. We at the journal are working to become indexed in PubMed, which will provide potential authors with an even wider and more prestigious exposure for their work. We invite you to visit our website and review this print journal to get an idea—if you don’t already have one—of the types of articles we publish. To jump-start your motivation, here is a brief description of the many types of articles we accept.

Feature Articles

Feature articles may be original research or comprehensive summaries of a clinically related topic. The possibilities are as endless as federal practice and could cover medications, other types of interventions (including psychosocial treatments), and reviews of diagnoses.

Original Research

We welcome empirical studies of completed research both biomedical and biobehavioral. More experienced and senior researchers might consider that publication in Federal Practitioner potentially can demonstrate their commitment to conducting research that benefits the members of the armed forces, public services, and veterans, to government funding agencies, increasingly a requirement for grants from those institutions. And for junior or new researchers, we offer a new option to publish pilot studies for research that is just getting launched or is on a smaller scale.

Case Reports

What health care professional has not had a case so memorable that he or she cannot forget it, or a patient encounter that made a lasting impression, or one in which they gained valuable medical knowledge or human wisdom? Ever thought of writing it up for your peers to learn from as well? Submit a case to Federal Practitioner and share your clinical pearls with your colleagues. The authoring process also gives you a chance to review the latest clinical literature on a diagnosis or treatment you wanted to know more about.

Program Profiles

This section of the journal reflects the unparalleled scope and resources of federal health care. Whether it is a national initiative or a local experiment, we want to know and let others read about the beneficial work that you are doing to care for service members, veterans, and the public. Submissions can be of innovative clinical or research projects or programs.

Guest Editorials

While usually members of the Editorial Advisory Association author guest editorials, we are pleased to consider high-quality, thought provoking editorials on themes of health care policy, organization, care delivery, ethics, and professionalism, among others.

Most of us have made the painful adjustment to daylight savings time. Use those extra hours of daylight to stimulate your creative brain. If writing a manuscript does not fit in to your busy schedule right now, think about becoming a peer reviewer or even a member of the Editorial Advisory Association. And last but not least, we are a friendly and open editorial team that is willing to entertain an imaginative suggestion for a manuscript that is novel and vital just like spring.

The Federal Practitioner submission guidelines, accessed at http://www.fedprac.com, include the journal’s style and format. If you need more information or have questions about submitting a manuscript to the journal, e-mail me at [email protected], Editor Reid Paul at [email protected],or Managing Editor Joyce Brody at [email protected].

March is National Professional Social Work Month, so it is an apt time to celebrate social workers’ contributions to our respective health care organizations. Military social workers are members of all 3 major federal practice organizations—DoD, VA, and the PHS—and fill a plethora of roles and positions, including active duty in all military branches and civilian social work. They operate in a variety of settings to provide counseling and case management among other services.

We all intuitively grasp that military service places immense stress and strain not only on soldiers, airmen, sailors, and marines, but also on their spouses and children. This is especially true during times of conflict and in theaters of combat. Social workers in the DoD provide consolation and consultation to the family unit of those who have been wounded in body or mind in Iraq, Afghanistan, and other war-torn areas.

In an article describing military social work, Nikki R. Wooten, PhD, offers this description of the profession: “Military social work is a specialized practice area that differs from generalized practice with civilians in that military personnel, veterans, and their families live, work, and receive health care and social benefits in a hierarchical, sociopolitical environment within a structured military organization.”¹

Unfortunately, as with other mental health specialties in federal practice, a shortage of social workers exists. In order to publicize the need and promote the education and training of social workers who specialize in the care of military members, their families, and veterans, Former First Lady Michelle Obama and former Second Lady Jill Biden, PhD, created Joining Forces. The program is a national effort to galvanize public support for all aspects of social and economic life for military service members and veterans. The National Association of Social Workers has been part of Joining Forces since 2011.

The VA employs more than 12,000 social workers, making the agency the largest employer of social workers in the U.S. Last year, the VA commemorated 90 years of social work excellence. Social workers are the front line for many of the most innovative social programs in the VA, such as the outreach to homeless veterans to locate and support housing; the medical foster home program for veterans who need assistance with activities of daily living that enables them to live with families in their home; the caregiver support program that assists friends and family to provide care for veterans who might otherwise not be able to live outside a facility; and the mental health intensive case management program that empowers veterans with serious mental illness to function as independently as possible and reduce the need for hospitalization.

Social workers also are part of the USPHS Commissioned Corps as allied health professionals. As crucial participants in multidisciplinary teams, social workers in the PHS respond to fill basic needs of people who are displaced by national disasters. They also provide mental health and clinical social work care in the clinics and hospitals of the IHS and other facilities that offer medical treatment and psychosocial intervention to disadvantaged populations and underserved regions. Social workers also offer public health education, social services, and administrative leadership.Another vital function that social workers perform in federal health care is facilitating the difficult transition of men and women from uniform to civilian life. A young person leaving the services needs the help of military social workers to negotiate the complexities of the VA health and education benefits application processes. Like runners in a relay, military and attached civilian social workers coordinate with VA social workers toward a smooth transition from one organization and way of life to another.

Social workers inhabit almost every corner of the federal health care world. Here are just a few examples from my own experience:

• The social worker is the first professional encounter for a service member returning from deployment and having difficulty adjusting, resulting in family dysfunction. Whether it is substance use treatment, marital counseling, or intimate partner violence, the social worker will be integral in coordinating the care of the service member and family.• The social worker is the professional who will arrange the discharge plan for an elderly veteran who has been hospitalized for cardiac surgery in a VAMC and requires a brief stay in a rehabilitation facility and then aid and assistance to return home to his wife of 40 years.
• The social worker is the professional at a vet center who provides confidential counseling to a veteran with posttraumatic stress disorder who does not feel safe or comfortable at a VAMC but who needs a therapist who has knowledge of the military and specialized trauma skills to help and heal. I suspect that if most readers of this column reflect on their federal career, they will remember an action of a social worker who smoothed their life path at a rough spot. Take a moment in this month to thank a social worker for giving help and hope to service members, veterans, and their families.

For more information
You can learn more about federal social workers by visiting the following organizations: National Association of Social Workers (https://www.socialworkers.org/military.asp), VA Social Work (http://www.socialwork.va.gov), Joining Forces (https://obamawhitehouse.archives.gov/joiningforces), and Social Work Today (http://www.socialworktoday.com/archive/031513p12.shtml).

March is National Professional Social Work Month, so it is an apt time to celebrate social workers’ contributions to our respective health care organizations. Military social workers are members of all 3 major federal practice organizations—DoD, VA, and the PHS—and fill a plethora of roles and positions, including active duty in all military branches and civilian social work. They operate in a variety of settings to provide counseling and case management among other services.

We all intuitively grasp that military service places immense stress and strain not only on soldiers, airmen, sailors, and marines, but also on their spouses and children. This is especially true during times of conflict and in theaters of combat. Social workers in the DoD provide consolation and consultation to the family unit of those who have been wounded in body or mind in Iraq, Afghanistan, and other war-torn areas.

In an article describing military social work, Nikki R. Wooten, PhD, offers this description of the profession: “Military social work is a specialized practice area that differs from generalized practice with civilians in that military personnel, veterans, and their families live, work, and receive health care and social benefits in a hierarchical, sociopolitical environment within a structured military organization.”¹

Unfortunately, as with other mental health specialties in federal practice, a shortage of social workers exists. In order to publicize the need and promote the education and training of social workers who specialize in the care of military members, their families, and veterans, Former First Lady Michelle Obama and former Second Lady Jill Biden, PhD, created Joining Forces. The program is a national effort to galvanize public support for all aspects of social and economic life for military service members and veterans. The National Association of Social Workers has been part of Joining Forces since 2011.

The VA employs more than 12,000 social workers, making the agency the largest employer of social workers in the U.S. Last year, the VA commemorated 90 years of social work excellence. Social workers are the front line for many of the most innovative social programs in the VA, such as the outreach to homeless veterans to locate and support housing; the medical foster home program for veterans who need assistance with activities of daily living that enables them to live with families in their home; the caregiver support program that assists friends and family to provide care for veterans who might otherwise not be able to live outside a facility; and the mental health intensive case management program that empowers veterans with serious mental illness to function as independently as possible and reduce the need for hospitalization.

Social workers also are part of the USPHS Commissioned Corps as allied health professionals. As crucial participants in multidisciplinary teams, social workers in the PHS respond to fill basic needs of people who are displaced by national disasters. They also provide mental health and clinical social work care in the clinics and hospitals of the IHS and other facilities that offer medical treatment and psychosocial intervention to disadvantaged populations and underserved regions. Social workers also offer public health education, social services, and administrative leadership.Another vital function that social workers perform in federal health care is facilitating the difficult transition of men and women from uniform to civilian life. A young person leaving the services needs the help of military social workers to negotiate the complexities of the VA health and education benefits application processes. Like runners in a relay, military and attached civilian social workers coordinate with VA social workers toward a smooth transition from one organization and way of life to another.

Social workers inhabit almost every corner of the federal health care world. Here are just a few examples from my own experience:

• The social worker is the first professional encounter for a service member returning from deployment and having difficulty adjusting, resulting in family dysfunction. Whether it is substance use treatment, marital counseling, or intimate partner violence, the social worker will be integral in coordinating the care of the service member and family.• The social worker is the professional who will arrange the discharge plan for an elderly veteran who has been hospitalized for cardiac surgery in a VAMC and requires a brief stay in a rehabilitation facility and then aid and assistance to return home to his wife of 40 years.
• The social worker is the professional at a vet center who provides confidential counseling to a veteran with posttraumatic stress disorder who does not feel safe or comfortable at a VAMC but who needs a therapist who has knowledge of the military and specialized trauma skills to help and heal. I suspect that if most readers of this column reflect on their federal career, they will remember an action of a social worker who smoothed their life path at a rough spot. Take a moment in this month to thank a social worker for giving help and hope to service members, veterans, and their families.

For more information
You can learn more about federal social workers by visiting the following organizations: National Association of Social Workers (https://www.socialworkers.org/military.asp), VA Social Work (http://www.socialwork.va.gov), Joining Forces (https://obamawhitehouse.archives.gov/joiningforces), and Social Work Today (http://www.socialworktoday.com/archive/031513p12.shtml).

March is National Professional Social Work Month, so it is an apt time to celebrate social workers’ contributions to our respective health care organizations. Military social workers are members of all 3 major federal practice organizations—DoD, VA, and the PHS—and fill a plethora of roles and positions, including active duty in all military branches and civilian social work. They operate in a variety of settings to provide counseling and case management among other services.

We all intuitively grasp that military service places immense stress and strain not only on soldiers, airmen, sailors, and marines, but also on their spouses and children. This is especially true during times of conflict and in theaters of combat. Social workers in the DoD provide consolation and consultation to the family unit of those who have been wounded in body or mind in Iraq, Afghanistan, and other war-torn areas.

In an article describing military social work, Nikki R. Wooten, PhD, offers this description of the profession: “Military social work is a specialized practice area that differs from generalized practice with civilians in that military personnel, veterans, and their families live, work, and receive health care and social benefits in a hierarchical, sociopolitical environment within a structured military organization.”¹

Unfortunately, as with other mental health specialties in federal practice, a shortage of social workers exists. In order to publicize the need and promote the education and training of social workers who specialize in the care of military members, their families, and veterans, Former First Lady Michelle Obama and former Second Lady Jill Biden, PhD, created Joining Forces. The program is a national effort to galvanize public support for all aspects of social and economic life for military service members and veterans. The National Association of Social Workers has been part of Joining Forces since 2011.

The VA employs more than 12,000 social workers, making the agency the largest employer of social workers in the U.S. Last year, the VA commemorated 90 years of social work excellence. Social workers are the front line for many of the most innovative social programs in the VA, such as the outreach to homeless veterans to locate and support housing; the medical foster home program for veterans who need assistance with activities of daily living that enables them to live with families in their home; the caregiver support program that assists friends and family to provide care for veterans who might otherwise not be able to live outside a facility; and the mental health intensive case management program that empowers veterans with serious mental illness to function as independently as possible and reduce the need for hospitalization.

Social workers also are part of the USPHS Commissioned Corps as allied health professionals. As crucial participants in multidisciplinary teams, social workers in the PHS respond to fill basic needs of people who are displaced by national disasters. They also provide mental health and clinical social work care in the clinics and hospitals of the IHS and other facilities that offer medical treatment and psychosocial intervention to disadvantaged populations and underserved regions. Social workers also offer public health education, social services, and administrative leadership.Another vital function that social workers perform in federal health care is facilitating the difficult transition of men and women from uniform to civilian life. A young person leaving the services needs the help of military social workers to negotiate the complexities of the VA health and education benefits application processes. Like runners in a relay, military and attached civilian social workers coordinate with VA social workers toward a smooth transition from one organization and way of life to another.

Social workers inhabit almost every corner of the federal health care world. Here are just a few examples from my own experience:

• The social worker is the first professional encounter for a service member returning from deployment and having difficulty adjusting, resulting in family dysfunction. Whether it is substance use treatment, marital counseling, or intimate partner violence, the social worker will be integral in coordinating the care of the service member and family.• The social worker is the professional who will arrange the discharge plan for an elderly veteran who has been hospitalized for cardiac surgery in a VAMC and requires a brief stay in a rehabilitation facility and then aid and assistance to return home to his wife of 40 years.
• The social worker is the professional at a vet center who provides confidential counseling to a veteran with posttraumatic stress disorder who does not feel safe or comfortable at a VAMC but who needs a therapist who has knowledge of the military and specialized trauma skills to help and heal. I suspect that if most readers of this column reflect on their federal career, they will remember an action of a social worker who smoothed their life path at a rough spot. Take a moment in this month to thank a social worker for giving help and hope to service members, veterans, and their families.

For more information
You can learn more about federal social workers by visiting the following organizations: National Association of Social Workers (https://www.socialworkers.org/military.asp), VA Social Work (http://www.socialwork.va.gov), Joining Forces (https://obamawhitehouse.archives.gov/joiningforces), and Social Work Today (http://www.socialworktoday.com/archive/031513p12.shtml).

The residency applicant walking with me through the lobby of the Albuquerque VA hospital on the way to an interview in my office asked me, “Are all VAs like this?” She was referring to the mariachi band that was entertaining veterans, families, and staff and the volunteer who was serving popcorn—for many years a regular feature at our VA. I responded, “No, they are all a little different, but yes, every VA is more than a hospital.” If she had asked a follow-up question, I would have added, “It is a community.”

Merriam-Webster’s Collegiate Dictionary has multiple definitions of community, and it is remarkable that most of them in one way or another describe the VA from the perspective of many veterans and even career employees:

• 1: a unified body of individuals: as
  a: state, commonwealth
  b: the people with common interests living in a particular area; broadly: the area itself (eg, the problems of a large community)
  c: an interacting population of various kinds of individuals (as species) in a common location
  d: a group of people with a common characteristic or interest in living together within a larger society (eg, a community of retired persons)
  e: a group linked by a common policy
  f: a body of persons or nations having a common history or common social, economic, and political interests (eg, the international community)
  g: a body of persons of common and especially professional interests scattered through a larger society (eg, the academic community)
• 2: society at large
• 3a: joint ownership or participation (community of goods)
  b: common character: likeness (community of interests)
  c: social activity: fellowship d: a social state or condition
  d: a social state or condition

There is much talk in the media about the privatization of the VA. There are zealous critics who argue that privatization would improve access and quality of care. I won’t debate that here.

What I want to consider is what the VA represents and provides in addition to health care. Each VA hospital and clinic serves “a body of persons or nations having a common history or common social, economic, and political interests.” Sit in the waiting area of any VA emergency department or pharmacy and you will hear bonding conversations between veterans. Even when the conversation is critical of the VA, it is because it is their hospital. That “joint ownership or participation” means that every VA employee, including the nearly 30% who wore a uniform, is there for a single purpose: to help veterans. That is our sole mission and advocacy.

Back to my VA. We are “a group of people with a common characteristic or interest living together within a larger society.” Similar to most other large medical centers, this VA is like the army base where I was born and raised—a small village. The single most popular service at my VA is the barber shop where veterans can get a haircut and shave. We also have an extensive clothing closet where eligible veterans experiencing tough times can get decent clothes.

Our VA, like almost any military base, has a post exchange that sells a little bit of everything from snacks to small appliances. When I was an intern, I treated an elderly patient who was in a deep psychotic depression and was transferred with only the clothes he was wearing. After several electroconvulsive treatments, I could tell he was feeling better when he asked me to buy him underwear from the post exchange downstairs. What this patient needed, the community provided.

A VA medical center is “a group of people with a common characteristic or interest living together within a larger society.” Like any American small town, there is a chapel where twice a year chaplains hold a memorial service for families and staff of patients who recently passed away in our hospital. At other times, we gather as a family of various and no faiths to grieve over the loss of a beloved fellow employee who, all too often, died too soon under tragic circumstances.

Much of this interaction naturally takes place around food. In the morning, there is a line at the coffee shop in the lobby that matches any Starbucks in town. Our VA also has an award-winning canteen that knows the favorite dishes of veterans and employees. If you go for breakfast or lunch, you will almost always run in to someone you have not seen in a while and have a quick visit.

At our VA, you also can browse kiosks of handcrafted items and military memorabilia and support small veteran-owned businesses. In good weather you can buy fruits and vegetables at the veteran farmers market and hear the stories of backyard gardeners and small farmers.

There are special events for every season. In the summer, concerts are held in the gazebo and veteran and guest musicians play all types of music. We even have a VA all-star band made up of current and former employees. The band is a big hit with patients and staff alike.

Although many of these community resources are unique to my VA, the effort to provide a welcoming atmosphere for veterans and health care providers to come together as a community is not unusual. Most VA medical centers have developed cultural responses to the needs of the veterans who return often over the course of years to their VA community.

One definition that does not apply to the large, diverse veteran population or to their health care providers is “a unified body of individuals.” There are many veterans who never have and never will set foot inside a VA hospital for many complex reasons. But for those who do call it home and want to receive care under VA auspices, a private VA would result in a deep and abiding loss of community. This loss is especially true for the most disadvantaged and vulnerable for whom the VA provides a broad and compassionate safety net. Under that protective tent, unbefriended veterans may grow closer to employees who have cared for them for years than to their family. Patients with complex medical and psychiatric needs, such as spinal cord injuries, polytrauma, substance use disorders, and posttraumatic stress disorder find specialized services dedicated to them that would be difficult to rival anywhere in the private sector.What also is not appreciated amid the fierce and too often well-deserved criticisms of VA business processes is that all VA health care practitioners are “a group linked by a common policy.” Even if we do not always live up to them, the VA has higher regulatory and ethical standards than almost any civilian health care organization. Ensuring those standards are followed in a myriad of health care entities not under VA policy and federal regulation seems a shibboleth.

The residency applicant walking with me through the lobby of the Albuquerque VA hospital on the way to an interview in my office asked me, “Are all VAs like this?” She was referring to the mariachi band that was entertaining veterans, families, and staff and the volunteer who was serving popcorn—for many years a regular feature at our VA. I responded, “No, they are all a little different, but yes, every VA is more than a hospital.” If she had asked a follow-up question, I would have added, “It is a community.”

Merriam-Webster’s Collegiate Dictionary has multiple definitions of community, and it is remarkable that most of them in one way or another describe the VA from the perspective of many veterans and even career employees:

• 1: a unified body of individuals: as
  a: state, commonwealth
  b: the people with common interests living in a particular area; broadly: the area itself (eg, the problems of a large community)
  c: an interacting population of various kinds of individuals (as species) in a common location
  d: a group of people with a common characteristic or interest in living together within a larger society (eg, a community of retired persons)
  e: a group linked by a common policy
  f: a body of persons or nations having a common history or common social, economic, and political interests (eg, the international community)
  g: a body of persons of common and especially professional interests scattered through a larger society (eg, the academic community)
• 2: society at large
• 3a: joint ownership or participation (community of goods)
  b: common character: likeness (community of interests)
  c: social activity: fellowship d: a social state or condition
  d: a social state or condition

There is much talk in the media about the privatization of the VA. There are zealous critics who argue that privatization would improve access and quality of care. I won’t debate that here.

What I want to consider is what the VA represents and provides in addition to health care. Each VA hospital and clinic serves “a body of persons or nations having a common history or common social, economic, and political interests.” Sit in the waiting area of any VA emergency department or pharmacy and you will hear bonding conversations between veterans. Even when the conversation is critical of the VA, it is because it is their hospital. That “joint ownership or participation” means that every VA employee, including the nearly 30% who wore a uniform, is there for a single purpose: to help veterans. That is our sole mission and advocacy.

Back to my VA. We are “a group of people with a common characteristic or interest living together within a larger society.” Similar to most other large medical centers, this VA is like the army base where I was born and raised—a small village. The single most popular service at my VA is the barber shop where veterans can get a haircut and shave. We also have an extensive clothing closet where eligible veterans experiencing tough times can get decent clothes.

Our VA, like almost any military base, has a post exchange that sells a little bit of everything from snacks to small appliances. When I was an intern, I treated an elderly patient who was in a deep psychotic depression and was transferred with only the clothes he was wearing. After several electroconvulsive treatments, I could tell he was feeling better when he asked me to buy him underwear from the post exchange downstairs. What this patient needed, the community provided.

A VA medical center is “a group of people with a common characteristic or interest living together within a larger society.” Like any American small town, there is a chapel where twice a year chaplains hold a memorial service for families and staff of patients who recently passed away in our hospital. At other times, we gather as a family of various and no faiths to grieve over the loss of a beloved fellow employee who, all too often, died too soon under tragic circumstances.

Much of this interaction naturally takes place around food. In the morning, there is a line at the coffee shop in the lobby that matches any Starbucks in town. Our VA also has an award-winning canteen that knows the favorite dishes of veterans and employees. If you go for breakfast or lunch, you will almost always run in to someone you have not seen in a while and have a quick visit.

At our VA, you also can browse kiosks of handcrafted items and military memorabilia and support small veteran-owned businesses. In good weather you can buy fruits and vegetables at the veteran farmers market and hear the stories of backyard gardeners and small farmers.

There are special events for every season. In the summer, concerts are held in the gazebo and veteran and guest musicians play all types of music. We even have a VA all-star band made up of current and former employees. The band is a big hit with patients and staff alike.

Although many of these community resources are unique to my VA, the effort to provide a welcoming atmosphere for veterans and health care providers to come together as a community is not unusual. Most VA medical centers have developed cultural responses to the needs of the veterans who return often over the course of years to their VA community.

One definition that does not apply to the large, diverse veteran population or to their health care providers is “a unified body of individuals.” There are many veterans who never have and never will set foot inside a VA hospital for many complex reasons. But for those who do call it home and want to receive care under VA auspices, a private VA would result in a deep and abiding loss of community. This loss is especially true for the most disadvantaged and vulnerable for whom the VA provides a broad and compassionate safety net. Under that protective tent, unbefriended veterans may grow closer to employees who have cared for them for years than to their family. Patients with complex medical and psychiatric needs, such as spinal cord injuries, polytrauma, substance use disorders, and posttraumatic stress disorder find specialized services dedicated to them that would be difficult to rival anywhere in the private sector.What also is not appreciated amid the fierce and too often well-deserved criticisms of VA business processes is that all VA health care practitioners are “a group linked by a common policy.” Even if we do not always live up to them, the VA has higher regulatory and ethical standards than almost any civilian health care organization. Ensuring those standards are followed in a myriad of health care entities not under VA policy and federal regulation seems a shibboleth.

The residency applicant walking with me through the lobby of the Albuquerque VA hospital on the way to an interview in my office asked me, “Are all VAs like this?” She was referring to the mariachi band that was entertaining veterans, families, and staff and the volunteer who was serving popcorn—for many years a regular feature at our VA. I responded, “No, they are all a little different, but yes, every VA is more than a hospital.” If she had asked a follow-up question, I would have added, “It is a community.”

Merriam-Webster’s Collegiate Dictionary has multiple definitions of community, and it is remarkable that most of them in one way or another describe the VA from the perspective of many veterans and even career employees:

• 1: a unified body of individuals: as
  a: state, commonwealth
  b: the people with common interests living in a particular area; broadly: the area itself (eg, the problems of a large community)
  c: an interacting population of various kinds of individuals (as species) in a common location
  d: a group of people with a common characteristic or interest in living together within a larger society (eg, a community of retired persons)
  e: a group linked by a common policy
  f: a body of persons or nations having a common history or common social, economic, and political interests (eg, the international community)
  g: a body of persons of common and especially professional interests scattered through a larger society (eg, the academic community)
• 2: society at large
• 3a: joint ownership or participation (community of goods)
  b: common character: likeness (community of interests)
  c: social activity: fellowship d: a social state or condition
  d: a social state or condition

There is much talk in the media about the privatization of the VA. There are zealous critics who argue that privatization would improve access and quality of care. I won’t debate that here.

What I want to consider is what the VA represents and provides in addition to health care. Each VA hospital and clinic serves “a body of persons or nations having a common history or common social, economic, and political interests.” Sit in the waiting area of any VA emergency department or pharmacy and you will hear bonding conversations between veterans. Even when the conversation is critical of the VA, it is because it is their hospital. That “joint ownership or participation” means that every VA employee, including the nearly 30% who wore a uniform, is there for a single purpose: to help veterans. That is our sole mission and advocacy.

Back to my VA. We are “a group of people with a common characteristic or interest living together within a larger society.” Similar to most other large medical centers, this VA is like the army base where I was born and raised—a small village. The single most popular service at my VA is the barber shop where veterans can get a haircut and shave. We also have an extensive clothing closet where eligible veterans experiencing tough times can get decent clothes.

Our VA, like almost any military base, has a post exchange that sells a little bit of everything from snacks to small appliances. When I was an intern, I treated an elderly patient who was in a deep psychotic depression and was transferred with only the clothes he was wearing. After several electroconvulsive treatments, I could tell he was feeling better when he asked me to buy him underwear from the post exchange downstairs. What this patient needed, the community provided.

A VA medical center is “a group of people with a common characteristic or interest living together within a larger society.” Like any American small town, there is a chapel where twice a year chaplains hold a memorial service for families and staff of patients who recently passed away in our hospital. At other times, we gather as a family of various and no faiths to grieve over the loss of a beloved fellow employee who, all too often, died too soon under tragic circumstances.

Much of this interaction naturally takes place around food. In the morning, there is a line at the coffee shop in the lobby that matches any Starbucks in town. Our VA also has an award-winning canteen that knows the favorite dishes of veterans and employees. If you go for breakfast or lunch, you will almost always run in to someone you have not seen in a while and have a quick visit.

At our VA, you also can browse kiosks of handcrafted items and military memorabilia and support small veteran-owned businesses. In good weather you can buy fruits and vegetables at the veteran farmers market and hear the stories of backyard gardeners and small farmers.

There are special events for every season. In the summer, concerts are held in the gazebo and veteran and guest musicians play all types of music. We even have a VA all-star band made up of current and former employees. The band is a big hit with patients and staff alike.

Although many of these community resources are unique to my VA, the effort to provide a welcoming atmosphere for veterans and health care providers to come together as a community is not unusual. Most VA medical centers have developed cultural responses to the needs of the veterans who return often over the course of years to their VA community.

One definition that does not apply to the large, diverse veteran population or to their health care providers is “a unified body of individuals.” There are many veterans who never have and never will set foot inside a VA hospital for many complex reasons. But for those who do call it home and want to receive care under VA auspices, a private VA would result in a deep and abiding loss of community. This loss is especially true for the most disadvantaged and vulnerable for whom the VA provides a broad and compassionate safety net. Under that protective tent, unbefriended veterans may grow closer to employees who have cared for them for years than to their family. Patients with complex medical and psychiatric needs, such as spinal cord injuries, polytrauma, substance use disorders, and posttraumatic stress disorder find specialized services dedicated to them that would be difficult to rival anywhere in the private sector.What also is not appreciated amid the fierce and too often well-deserved criticisms of VA business processes is that all VA health care practitioners are “a group linked by a common policy.” Even if we do not always live up to them, the VA has higher regulatory and ethical standards than almost any civilian health care organization. Ensuring those standards are followed in a myriad of health care entities not under VA policy and federal regulation seems a shibboleth.

It has been a long time since a new year has brought as much uncertainty as 2017 promises to bring, making some federal employees excited and others apprehensive. Rumors abound of how the federal health care sector may change: Hiring freezes, manpower cuts, and privatization are all concerns of Federal Practitioner readers. As in the past, we will keep you up-to-date with in-depth interviews of leaders in federal health care, intelligent coverage of news stories impacting your practice, and clinical and research articles about new programs and initiatives.

Also this year, we are pleased to announce several new regular columns that we hope will inform and entertain you. The first is a column on mental health and traumatic brain injury in the DoD and the VA. We are privileged to have U.S. Army COL (Ret) Elspeth Cameron Ritchie, MD, MPH, edit this column. She is widely known and respected and brings her vast experience to the column as an active-duty psychiatrist coupled with her current position as a VA physician. Dr. Ritchie will author articles as well as edit those of her VA and DoD colleagues. Mental health touches almost every aspect of federal practice, and we all will learn our contributions and challenges in this rapidly moving specialty.

Whereas the mental health column looks toward the scientific future, the second column looks back to the humanistic past. We are thrilled that 2 physician-historians of military medicine, Robert Hierholzer, MD, a VA psychiatrist, and John Pierce, MD, a retired U.S. Army pediatrician share the writing and editing for this column, which will debut this spring.

Have you ever wondered who or how VA and military hospitals were named? These 2 historical writers have a wealth of interesting anecdotes and stories about VA and military medical centers. We hope you will enjoy reading the stories of military and veteran health care: the war heroes, devoted clinicians, and groundbreaking researchers who have left their mark on DoD and VA health care.

We also will be launching a new pilot study feature for clinicians and researchers who have a novel or valuable idea but have only a small number of participants or preliminary results. This will be a great way for new investigators, trainees, and young health care practitioners to present their work to the medical community.

These new editorial offerings are just a start—we also want to invite you, your colleagues, and learners to start your own new tradition of writing for Federal Practitioner. For those who have submitted articles in the past, please keep up the habit.We are eager to receive original research, review articles, and clinical cases from DoD, PHS, and VA mid-career and senior clinicians and researchers as well as articles describing innovative programs and modes of health care treatment and delivery. With a print circulation of more than 35,000 readers and very active online presence, consider Federal Practitioner for your next article!

This year my New Year’s resolution as editor-in-chief is to encourage readers to contact either Editor Reid Paul or me if you have an idea for an article you would like to write, a column you would like to see, or if you have an interest in serving as a peer reviewer or joining our Editorial Advisory Association. We want to hear from you about what you want and need from Federal Practitioner. You can contact the editorial team at [email protected].

Author disclosures

The author reports no actual or potential conflicts of interest with regard to this article.

Disclaimer

The opinions expressed herein are those of the author and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the U.S. Government, or any of its agencies.

It has been a long time since a new year has brought as much uncertainty as 2017 promises to bring, making some federal employees excited and others apprehensive. Rumors abound of how the federal health care sector may change: Hiring freezes, manpower cuts, and privatization are all concerns of Federal Practitioner readers. As in the past, we will keep you up-to-date with in-depth interviews of leaders in federal health care, intelligent coverage of news stories impacting your practice, and clinical and research articles about new programs and initiatives.

Also this year, we are pleased to announce several new regular columns that we hope will inform and entertain you. The first is a column on mental health and traumatic brain injury in the DoD and the VA. We are privileged to have U.S. Army COL (Ret) Elspeth Cameron Ritchie, MD, MPH, edit this column. She is widely known and respected and brings her vast experience to the column as an active-duty psychiatrist coupled with her current position as a VA physician. Dr. Ritchie will author articles as well as edit those of her VA and DoD colleagues. Mental health touches almost every aspect of federal practice, and we all will learn our contributions and challenges in this rapidly moving specialty.

Whereas the mental health column looks toward the scientific future, the second column looks back to the humanistic past. We are thrilled that 2 physician-historians of military medicine, Robert Hierholzer, MD, a VA psychiatrist, and John Pierce, MD, a retired U.S. Army pediatrician share the writing and editing for this column, which will debut this spring.

Have you ever wondered who or how VA and military hospitals were named? These 2 historical writers have a wealth of interesting anecdotes and stories about VA and military medical centers. We hope you will enjoy reading the stories of military and veteran health care: the war heroes, devoted clinicians, and groundbreaking researchers who have left their mark on DoD and VA health care.

We also will be launching a new pilot study feature for clinicians and researchers who have a novel or valuable idea but have only a small number of participants or preliminary results. This will be a great way for new investigators, trainees, and young health care practitioners to present their work to the medical community.

These new editorial offerings are just a start—we also want to invite you, your colleagues, and learners to start your own new tradition of writing for Federal Practitioner. For those who have submitted articles in the past, please keep up the habit.We are eager to receive original research, review articles, and clinical cases from DoD, PHS, and VA mid-career and senior clinicians and researchers as well as articles describing innovative programs and modes of health care treatment and delivery. With a print circulation of more than 35,000 readers and very active online presence, consider Federal Practitioner for your next article!

This year my New Year’s resolution as editor-in-chief is to encourage readers to contact either Editor Reid Paul or me if you have an idea for an article you would like to write, a column you would like to see, or if you have an interest in serving as a peer reviewer or joining our Editorial Advisory Association. We want to hear from you about what you want and need from Federal Practitioner. You can contact the editorial team at [email protected].

Author disclosures

The author reports no actual or potential conflicts of interest with regard to this article.

Disclaimer

The opinions expressed herein are those of the author and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the U.S. Government, or any of its agencies.

It has been a long time since a new year has brought as much uncertainty as 2017 promises to bring, making some federal employees excited and others apprehensive. Rumors abound of how the federal health care sector may change: Hiring freezes, manpower cuts, and privatization are all concerns of Federal Practitioner readers. As in the past, we will keep you up-to-date with in-depth interviews of leaders in federal health care, intelligent coverage of news stories impacting your practice, and clinical and research articles about new programs and initiatives.

Also this year, we are pleased to announce several new regular columns that we hope will inform and entertain you. The first is a column on mental health and traumatic brain injury in the DoD and the VA. We are privileged to have U.S. Army COL (Ret) Elspeth Cameron Ritchie, MD, MPH, edit this column. She is widely known and respected and brings her vast experience to the column as an active-duty psychiatrist coupled with her current position as a VA physician. Dr. Ritchie will author articles as well as edit those of her VA and DoD colleagues. Mental health touches almost every aspect of federal practice, and we all will learn our contributions and challenges in this rapidly moving specialty.

Whereas the mental health column looks toward the scientific future, the second column looks back to the humanistic past. We are thrilled that 2 physician-historians of military medicine, Robert Hierholzer, MD, a VA psychiatrist, and John Pierce, MD, a retired U.S. Army pediatrician share the writing and editing for this column, which will debut this spring.

Have you ever wondered who or how VA and military hospitals were named? These 2 historical writers have a wealth of interesting anecdotes and stories about VA and military medical centers. We hope you will enjoy reading the stories of military and veteran health care: the war heroes, devoted clinicians, and groundbreaking researchers who have left their mark on DoD and VA health care.

We also will be launching a new pilot study feature for clinicians and researchers who have a novel or valuable idea but have only a small number of participants or preliminary results. This will be a great way for new investigators, trainees, and young health care practitioners to present their work to the medical community.

These new editorial offerings are just a start—we also want to invite you, your colleagues, and learners to start your own new tradition of writing for Federal Practitioner. For those who have submitted articles in the past, please keep up the habit.We are eager to receive original research, review articles, and clinical cases from DoD, PHS, and VA mid-career and senior clinicians and researchers as well as articles describing innovative programs and modes of health care treatment and delivery. With a print circulation of more than 35,000 readers and very active online presence, consider Federal Practitioner for your next article!

This year my New Year’s resolution as editor-in-chief is to encourage readers to contact either Editor Reid Paul or me if you have an idea for an article you would like to write, a column you would like to see, or if you have an interest in serving as a peer reviewer or joining our Editorial Advisory Association. We want to hear from you about what you want and need from Federal Practitioner. You can contact the editorial team at [email protected].

Author disclosures

The author reports no actual or potential conflicts of interest with regard to this article.

Disclaimer

The opinions expressed herein are those of the author and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the U.S. Government, or any of its agencies.

And remember: you must never, under any circumstances, despair. To hope and to act, these are our duties in misfortune.

—Boris Pasternak, Doctor Zhivago

This editorial is being written on Veterans Day. Likely you will read it when the stores and streets are lined with holiday decorations. Thanksgiving will have come and gone. All these celebrations have the common themes of giving and gratitude, and among the many requests clamoring for your attention at this season are care package collections for active-duty service members and donations for disadvantaged veterans. These efforts are well intentioned on the part of givers and appreciated on the part of those who receive them. Yet these themes remind me of the hackneyed saying we likely have all heard, and many of us have said: Thank you for your service.

Many of you may recall the controversy that emerged surrounding this seemingly innocuous cliché. It has had an Internet resurgence on this day set out to honor those who wore or are in uniform.¹ For those who don’t remember the phenomenon, I will briefly summarize. A journalist was interviewing a combat veteran from Afghanistan on a different subject but knowing he had been in the military and the reporter thinking he was being kind and respectful, like so many of us, thanked him for his service. The astute journalist could tell from the expression on the veteran’s face that the comment had touched a wound he never expected to open. But he cared enough to try and understand how the veteran heard these words from out of the depths of his memories of war.

The emotions that emerged from the interview and the online blogs and comments that followed reflect the toll that war takes: anger, anguish, alienation, which these “have a nice day” words seem to evoke, even though they are never meant to create distance, dismissal, or dishonor. This interaction was a painful one for the veteran, and even for the journalist, and created what psychologists call cognitive dissonance, “a condition of conflict or anxiety resulting from inconsistency between belief and action.”²

The reason those 5 words strike a raw nerve in some—but by no means all—who were or are in the armed forces is that those to whom they are spoken know in a deep and personal way, that we who say them usually do not know what we are talking about. I can see this reaction when I watch several of my VA colleagues who actually are combat veterans say the words but from a different theory of mind, a theory of mind they share. Theory of mind is another psychological concept that is at the core of interpersonal and communication skills, the ability to see and feel the world as another person sees it. When someone who has never fought or even served says “thank you for your service,” some veterans feel that their individual experience of combat or even of being in the military is being expressed inauthentically, even perhaps insincerely.

“To these vets, thanking soldiers for their service symbolizes the ease of sending a volunteer army to wage war at great distance—physically, spiritually, economically,” journalist Matt Richtel writes. “It raises questions of the meaning of patriotism, shared purpose and, pointedly, what you’re supposed to say to those who put their lives on the line and are uncomfortable about being thanked for it.”²

My father, a World War II combat veteran and career army physician, told me when I was young that there were 3 experiences that could never be understood unless you lived them: pregnancy, medical school, and combat. I’m not sure why or how he chose these although I am sure they were not original, but having gone through the second, I believe it was because these events are of such personal intensity, such immediate contact with the human condition in all its suffering and resilience that they cannot be faithfully replicated in any in vitro simulation but only in vivo.

Which brings me to the title of the column. How can we say thank you to our friends and family members, our coworkers, and our patients who went to war and returned, who enlisted ready to go into combat even if the fates did not send them? Reading the comments of these men and women in response to the superficial phrase with which we habitually acknowledge their sacrifice leaves me wondering what to say to express our obligation to those who struggled through foreign tribulations while we remained safe at home. Their reflections offer some surprising suggestions that seem prophetic as we as a country process the results of the recent election with grief, triumph, or indifference.

We can say thank you through voting, donations, or advocacy as long as we act to promote the most fundamental good for humanity. We say thank you when we act to help a veteran to live a decent and rewarding life, to have a safe place to live, to grow through education, to share life with companions, and to find a job or another way to contribute to society. Actions to improve the living conditions of veterans now and a better future for those who leave the ranks are seeds of gratitude that come to fruition long after the empty phrases are forgotten.

We say thank you when we think and question long and hard until it hurts, until we too experience cognitive dissonance, until our theory of mind is stretched beyond its comfortable boundaries about the purpose of war in general and the justification for any particular conflict in which our government contemplates sending the young and brave to fight and die. Acting and thinking honor sacrifice as words never can.

And remember: you must never, under any circumstances, despair. To hope and to act, these are our duties in misfortune.

—Boris Pasternak, Doctor Zhivago

This editorial is being written on Veterans Day. Likely you will read it when the stores and streets are lined with holiday decorations. Thanksgiving will have come and gone. All these celebrations have the common themes of giving and gratitude, and among the many requests clamoring for your attention at this season are care package collections for active-duty service members and donations for disadvantaged veterans. These efforts are well intentioned on the part of givers and appreciated on the part of those who receive them. Yet these themes remind me of the hackneyed saying we likely have all heard, and many of us have said: Thank you for your service.

Many of you may recall the controversy that emerged surrounding this seemingly innocuous cliché. It has had an Internet resurgence on this day set out to honor those who wore or are in uniform.¹ For those who don’t remember the phenomenon, I will briefly summarize. A journalist was interviewing a combat veteran from Afghanistan on a different subject but knowing he had been in the military and the reporter thinking he was being kind and respectful, like so many of us, thanked him for his service. The astute journalist could tell from the expression on the veteran’s face that the comment had touched a wound he never expected to open. But he cared enough to try and understand how the veteran heard these words from out of the depths of his memories of war.

The emotions that emerged from the interview and the online blogs and comments that followed reflect the toll that war takes: anger, anguish, alienation, which these “have a nice day” words seem to evoke, even though they are never meant to create distance, dismissal, or dishonor. This interaction was a painful one for the veteran, and even for the journalist, and created what psychologists call cognitive dissonance, “a condition of conflict or anxiety resulting from inconsistency between belief and action.”²

The reason those 5 words strike a raw nerve in some—but by no means all—who were or are in the armed forces is that those to whom they are spoken know in a deep and personal way, that we who say them usually do not know what we are talking about. I can see this reaction when I watch several of my VA colleagues who actually are combat veterans say the words but from a different theory of mind, a theory of mind they share. Theory of mind is another psychological concept that is at the core of interpersonal and communication skills, the ability to see and feel the world as another person sees it. When someone who has never fought or even served says “thank you for your service,” some veterans feel that their individual experience of combat or even of being in the military is being expressed inauthentically, even perhaps insincerely.

“To these vets, thanking soldiers for their service symbolizes the ease of sending a volunteer army to wage war at great distance—physically, spiritually, economically,” journalist Matt Richtel writes. “It raises questions of the meaning of patriotism, shared purpose and, pointedly, what you’re supposed to say to those who put their lives on the line and are uncomfortable about being thanked for it.”²

My father, a World War II combat veteran and career army physician, told me when I was young that there were 3 experiences that could never be understood unless you lived them: pregnancy, medical school, and combat. I’m not sure why or how he chose these although I am sure they were not original, but having gone through the second, I believe it was because these events are of such personal intensity, such immediate contact with the human condition in all its suffering and resilience that they cannot be faithfully replicated in any in vitro simulation but only in vivo.

Which brings me to the title of the column. How can we say thank you to our friends and family members, our coworkers, and our patients who went to war and returned, who enlisted ready to go into combat even if the fates did not send them? Reading the comments of these men and women in response to the superficial phrase with which we habitually acknowledge their sacrifice leaves me wondering what to say to express our obligation to those who struggled through foreign tribulations while we remained safe at home. Their reflections offer some surprising suggestions that seem prophetic as we as a country process the results of the recent election with grief, triumph, or indifference.

We can say thank you through voting, donations, or advocacy as long as we act to promote the most fundamental good for humanity. We say thank you when we act to help a veteran to live a decent and rewarding life, to have a safe place to live, to grow through education, to share life with companions, and to find a job or another way to contribute to society. Actions to improve the living conditions of veterans now and a better future for those who leave the ranks are seeds of gratitude that come to fruition long after the empty phrases are forgotten.

We say thank you when we think and question long and hard until it hurts, until we too experience cognitive dissonance, until our theory of mind is stretched beyond its comfortable boundaries about the purpose of war in general and the justification for any particular conflict in which our government contemplates sending the young and brave to fight and die. Acting and thinking honor sacrifice as words never can.

And remember: you must never, under any circumstances, despair. To hope and to act, these are our duties in misfortune.

—Boris Pasternak, Doctor Zhivago

This editorial is being written on Veterans Day. Likely you will read it when the stores and streets are lined with holiday decorations. Thanksgiving will have come and gone. All these celebrations have the common themes of giving and gratitude, and among the many requests clamoring for your attention at this season are care package collections for active-duty service members and donations for disadvantaged veterans. These efforts are well intentioned on the part of givers and appreciated on the part of those who receive them. Yet these themes remind me of the hackneyed saying we likely have all heard, and many of us have said: Thank you for your service.

Many of you may recall the controversy that emerged surrounding this seemingly innocuous cliché. It has had an Internet resurgence on this day set out to honor those who wore or are in uniform.¹ For those who don’t remember the phenomenon, I will briefly summarize. A journalist was interviewing a combat veteran from Afghanistan on a different subject but knowing he had been in the military and the reporter thinking he was being kind and respectful, like so many of us, thanked him for his service. The astute journalist could tell from the expression on the veteran’s face that the comment had touched a wound he never expected to open. But he cared enough to try and understand how the veteran heard these words from out of the depths of his memories of war.

The emotions that emerged from the interview and the online blogs and comments that followed reflect the toll that war takes: anger, anguish, alienation, which these “have a nice day” words seem to evoke, even though they are never meant to create distance, dismissal, or dishonor. This interaction was a painful one for the veteran, and even for the journalist, and created what psychologists call cognitive dissonance, “a condition of conflict or anxiety resulting from inconsistency between belief and action.”²

The reason those 5 words strike a raw nerve in some—but by no means all—who were or are in the armed forces is that those to whom they are spoken know in a deep and personal way, that we who say them usually do not know what we are talking about. I can see this reaction when I watch several of my VA colleagues who actually are combat veterans say the words but from a different theory of mind, a theory of mind they share. Theory of mind is another psychological concept that is at the core of interpersonal and communication skills, the ability to see and feel the world as another person sees it. When someone who has never fought or even served says “thank you for your service,” some veterans feel that their individual experience of combat or even of being in the military is being expressed inauthentically, even perhaps insincerely.

“To these vets, thanking soldiers for their service symbolizes the ease of sending a volunteer army to wage war at great distance—physically, spiritually, economically,” journalist Matt Richtel writes. “It raises questions of the meaning of patriotism, shared purpose and, pointedly, what you’re supposed to say to those who put their lives on the line and are uncomfortable about being thanked for it.”²

My father, a World War II combat veteran and career army physician, told me when I was young that there were 3 experiences that could never be understood unless you lived them: pregnancy, medical school, and combat. I’m not sure why or how he chose these although I am sure they were not original, but having gone through the second, I believe it was because these events are of such personal intensity, such immediate contact with the human condition in all its suffering and resilience that they cannot be faithfully replicated in any in vitro simulation but only in vivo.

Which brings me to the title of the column. How can we say thank you to our friends and family members, our coworkers, and our patients who went to war and returned, who enlisted ready to go into combat even if the fates did not send them? Reading the comments of these men and women in response to the superficial phrase with which we habitually acknowledge their sacrifice leaves me wondering what to say to express our obligation to those who struggled through foreign tribulations while we remained safe at home. Their reflections offer some surprising suggestions that seem prophetic as we as a country process the results of the recent election with grief, triumph, or indifference.

We can say thank you through voting, donations, or advocacy as long as we act to promote the most fundamental good for humanity. We say thank you when we act to help a veteran to live a decent and rewarding life, to have a safe place to live, to grow through education, to share life with companions, and to find a job or another way to contribute to society. Actions to improve the living conditions of veterans now and a better future for those who leave the ranks are seeds of gratitude that come to fruition long after the empty phrases are forgotten.

We say thank you when we think and question long and hard until it hurts, until we too experience cognitive dissonance, until our theory of mind is stretched beyond its comfortable boundaries about the purpose of war in general and the justification for any particular conflict in which our government contemplates sending the young and brave to fight and die. Acting and thinking honor sacrifice as words never can.

Given the recently concluded election season, it may seem that there are few things Americans have in common or can agree on. And although I did not conduct a poll or hold a debate, I suspect that a majority of those who work in the VA, DoD, or PHS would agree that one of the most serious and prevalent public health problems facing those in federal service and in the country at large is the epidemic of substance use disorders (SUDs).

In 2013 the National Institute on Drug Abuse reported that “members of the armed forces are not immune to the substance use problems that affect the rest of society.”¹ Although active-duty service members use illicit drugs less frequently, as would be expected given the potential disciplinary consequences, the prevalence of problematic use of the legal ones—tobacco, alcohol, and particularly prescription medications—is greater among individuals in the military.

Substance use disorders affect every sector of federal health care practice from military pediatrics and VA pathology to PHS primary care. Reflecting this ubiquity, in this special substance use disorders issue of Federal Practitioner we focus on several distinctive and significant efforts of health care practitioners who care for patients with SUDs. All of medicine is becoming more interdisciplinary, multidisciplinary, and team-based, but perhaps no other area has as long a legacy or as intrinsic a need for team approaches to care than does the diagnosis and treatment of SUDs. We see this need reflected in this issue’s articles authored by clinical pharmacists, nurse practitioners, physicians, and physicians in training, among others.

Prescription opioids are the subject of 3 articles from VA practitioners: a look at primary, secondary, and tertiary forms of prevention of morbidity and mortality from substance use. Pharmacists at the Salt Lake City VAMC studied the epidemiology of veterans seen in emergency departments who were given naloxone for unintentional opioid overdoses. A second article reviews the distribution of naloxone at a VA facility, providing an example of a successful implementation of the VA Overdose Education and Naloxone Distribution network (OEND)—the only national naloxone program in any health care system.

Even farther upstream in the effort to reduce the large doses of opioids that are directly related to overdose deaths is an article on an outpatient opioid-monitoring clinic that uses evidence-based medicine to diagnose patients with opioid use disorder. Research in the VHA showed that in a 4-year period of study, “the risk of overdose deaths was directly related to the maximum prescribed daily dose of opioid medication.”²

Our colleagues in active duty underscore the challenge that new and emerging substances present not only to federal regulatory agencies like the Drug Enforcement Agency, but also to state and local law enforcement agencies. When spice (synthetic cannabinoids) and bath salts (synthetic cathinones) first appeared, no drug tests were available to detect them. Technically not illegal in the early phase of their use, they became the perfect and popular drugs of young service men and women.³

Tragically, history has shown 2 truths about humans and the use of psychoactive products. The first is that as soon as one product is outlawed, creative chemists invent another mind-altering product. Practical education regarding the latest of these underground drugs, kratom, which threatens our service members, is introduced in this issue.

The second truth is that nearly every drug that is originally prescribed for legitimate medical reasons is eventually misused for a nonmedical purpose and can lead to SUDs. By the time the medical community realizes the dark side of the medication, many individuals have already developed a disorder, and sadly some have died.

One of the oldest classes of drugs that brings both relief and torment to human culture—opioid medication—is now the scourge of postmodern society. Our well-intentioned efforts to succor real pain for patients using prescription opioids have paved a road to hellish suffering for others. A recent study examined whether a resurgence of heroin use among veterans—the likes of which has not been seen since the Vietnam era—was associated with the nonmedical use of yes, prescribed narcotics. The same study found that solely having chronic pain was not correlated with the use of heroin.⁴ This finding offers the hope that practitioners and patients together can learn to treat chronic pain with opioids in selected patients, which can be life-restoring in appropriate cases for limited duration, safely and responsibly while avoiding and minimizing the death dealing blow of opioid use disorders.

In this issue, we also feature a discussion with Karen Drexler, MD, the newly appointed Mental Health Program Director, Addictive Disorders. Dr. Drexler expertly discusses a wide array of SUD subjects relevant to Federal Practitioner readers, including the approach to patients using medical marijuana in the VA, the 2016 VA/DoD Clinical Practice Guidelines, and an inside view of the challenges and successes of VA SUD programs, from the vantage point of the new leader of these critical initiatives.

Finally, astute readers may notice the editorial attempts to avoid use of the value-laden terms addiction and substance abuse. Instead, the less stigmatizing terminology of DSM-5 is employed, which jettisons the problematic abuse and dependence distinction for the unitary domain of SUDs. This approach is not just a change in semantics but as thought leaders have shown, a real and meaningful comprehension of the role of words in shaping culture.⁵ The VA as a health care entity is moving to adopt better scientific framing of SUDs as a salient step toward a recovery-oriented program.

In the coming months, we intend to expand our coverage of this public health crisis, and we invite readers who care every day for patients wrestling with SUDs for control of their health and very lives, to educate, advocate for resources for active-duty service personnel and veterans, and share innovative efforts to turn the tide toward recovery.

Given the recently concluded election season, it may seem that there are few things Americans have in common or can agree on. And although I did not conduct a poll or hold a debate, I suspect that a majority of those who work in the VA, DoD, or PHS would agree that one of the most serious and prevalent public health problems facing those in federal service and in the country at large is the epidemic of substance use disorders (SUDs).

In 2013 the National Institute on Drug Abuse reported that “members of the armed forces are not immune to the substance use problems that affect the rest of society.”¹ Although active-duty service members use illicit drugs less frequently, as would be expected given the potential disciplinary consequences, the prevalence of problematic use of the legal ones—tobacco, alcohol, and particularly prescription medications—is greater among individuals in the military.

Substance use disorders affect every sector of federal health care practice from military pediatrics and VA pathology to PHS primary care. Reflecting this ubiquity, in this special substance use disorders issue of Federal Practitioner we focus on several distinctive and significant efforts of health care practitioners who care for patients with SUDs. All of medicine is becoming more interdisciplinary, multidisciplinary, and team-based, but perhaps no other area has as long a legacy or as intrinsic a need for team approaches to care than does the diagnosis and treatment of SUDs. We see this need reflected in this issue’s articles authored by clinical pharmacists, nurse practitioners, physicians, and physicians in training, among others.

Prescription opioids are the subject of 3 articles from VA practitioners: a look at primary, secondary, and tertiary forms of prevention of morbidity and mortality from substance use. Pharmacists at the Salt Lake City VAMC studied the epidemiology of veterans seen in emergency departments who were given naloxone for unintentional opioid overdoses. A second article reviews the distribution of naloxone at a VA facility, providing an example of a successful implementation of the VA Overdose Education and Naloxone Distribution network (OEND)—the only national naloxone program in any health care system.

Even farther upstream in the effort to reduce the large doses of opioids that are directly related to overdose deaths is an article on an outpatient opioid-monitoring clinic that uses evidence-based medicine to diagnose patients with opioid use disorder. Research in the VHA showed that in a 4-year period of study, “the risk of overdose deaths was directly related to the maximum prescribed daily dose of opioid medication.”²

Our colleagues in active duty underscore the challenge that new and emerging substances present not only to federal regulatory agencies like the Drug Enforcement Agency, but also to state and local law enforcement agencies. When spice (synthetic cannabinoids) and bath salts (synthetic cathinones) first appeared, no drug tests were available to detect them. Technically not illegal in the early phase of their use, they became the perfect and popular drugs of young service men and women.³

Tragically, history has shown 2 truths about humans and the use of psychoactive products. The first is that as soon as one product is outlawed, creative chemists invent another mind-altering product. Practical education regarding the latest of these underground drugs, kratom, which threatens our service members, is introduced in this issue.

The second truth is that nearly every drug that is originally prescribed for legitimate medical reasons is eventually misused for a nonmedical purpose and can lead to SUDs. By the time the medical community realizes the dark side of the medication, many individuals have already developed a disorder, and sadly some have died.

One of the oldest classes of drugs that brings both relief and torment to human culture—opioid medication—is now the scourge of postmodern society. Our well-intentioned efforts to succor real pain for patients using prescription opioids have paved a road to hellish suffering for others. A recent study examined whether a resurgence of heroin use among veterans—the likes of which has not been seen since the Vietnam era—was associated with the nonmedical use of yes, prescribed narcotics. The same study found that solely having chronic pain was not correlated with the use of heroin.⁴ This finding offers the hope that practitioners and patients together can learn to treat chronic pain with opioids in selected patients, which can be life-restoring in appropriate cases for limited duration, safely and responsibly while avoiding and minimizing the death dealing blow of opioid use disorders.

In this issue, we also feature a discussion with Karen Drexler, MD, the newly appointed Mental Health Program Director, Addictive Disorders. Dr. Drexler expertly discusses a wide array of SUD subjects relevant to Federal Practitioner readers, including the approach to patients using medical marijuana in the VA, the 2016 VA/DoD Clinical Practice Guidelines, and an inside view of the challenges and successes of VA SUD programs, from the vantage point of the new leader of these critical initiatives.

Finally, astute readers may notice the editorial attempts to avoid use of the value-laden terms addiction and substance abuse. Instead, the less stigmatizing terminology of DSM-5 is employed, which jettisons the problematic abuse and dependence distinction for the unitary domain of SUDs. This approach is not just a change in semantics but as thought leaders have shown, a real and meaningful comprehension of the role of words in shaping culture.⁵ The VA as a health care entity is moving to adopt better scientific framing of SUDs as a salient step toward a recovery-oriented program.

In the coming months, we intend to expand our coverage of this public health crisis, and we invite readers who care every day for patients wrestling with SUDs for control of their health and very lives, to educate, advocate for resources for active-duty service personnel and veterans, and share innovative efforts to turn the tide toward recovery.

Given the recently concluded election season, it may seem that there are few things Americans have in common or can agree on. And although I did not conduct a poll or hold a debate, I suspect that a majority of those who work in the VA, DoD, or PHS would agree that one of the most serious and prevalent public health problems facing those in federal service and in the country at large is the epidemic of substance use disorders (SUDs).

In 2013 the National Institute on Drug Abuse reported that “members of the armed forces are not immune to the substance use problems that affect the rest of society.”¹ Although active-duty service members use illicit drugs less frequently, as would be expected given the potential disciplinary consequences, the prevalence of problematic use of the legal ones—tobacco, alcohol, and particularly prescription medications—is greater among individuals in the military.

Substance use disorders affect every sector of federal health care practice from military pediatrics and VA pathology to PHS primary care. Reflecting this ubiquity, in this special substance use disorders issue of Federal Practitioner we focus on several distinctive and significant efforts of health care practitioners who care for patients with SUDs. All of medicine is becoming more interdisciplinary, multidisciplinary, and team-based, but perhaps no other area has as long a legacy or as intrinsic a need for team approaches to care than does the diagnosis and treatment of SUDs. We see this need reflected in this issue’s articles authored by clinical pharmacists, nurse practitioners, physicians, and physicians in training, among others.

Prescription opioids are the subject of 3 articles from VA practitioners: a look at primary, secondary, and tertiary forms of prevention of morbidity and mortality from substance use. Pharmacists at the Salt Lake City VAMC studied the epidemiology of veterans seen in emergency departments who were given naloxone for unintentional opioid overdoses. A second article reviews the distribution of naloxone at a VA facility, providing an example of a successful implementation of the VA Overdose Education and Naloxone Distribution network (OEND)—the only national naloxone program in any health care system.

Even farther upstream in the effort to reduce the large doses of opioids that are directly related to overdose deaths is an article on an outpatient opioid-monitoring clinic that uses evidence-based medicine to diagnose patients with opioid use disorder. Research in the VHA showed that in a 4-year period of study, “the risk of overdose deaths was directly related to the maximum prescribed daily dose of opioid medication.”²

Our colleagues in active duty underscore the challenge that new and emerging substances present not only to federal regulatory agencies like the Drug Enforcement Agency, but also to state and local law enforcement agencies. When spice (synthetic cannabinoids) and bath salts (synthetic cathinones) first appeared, no drug tests were available to detect them. Technically not illegal in the early phase of their use, they became the perfect and popular drugs of young service men and women.³

Tragically, history has shown 2 truths about humans and the use of psychoactive products. The first is that as soon as one product is outlawed, creative chemists invent another mind-altering product. Practical education regarding the latest of these underground drugs, kratom, which threatens our service members, is introduced in this issue.

The second truth is that nearly every drug that is originally prescribed for legitimate medical reasons is eventually misused for a nonmedical purpose and can lead to SUDs. By the time the medical community realizes the dark side of the medication, many individuals have already developed a disorder, and sadly some have died.

One of the oldest classes of drugs that brings both relief and torment to human culture—opioid medication—is now the scourge of postmodern society. Our well-intentioned efforts to succor real pain for patients using prescription opioids have paved a road to hellish suffering for others. A recent study examined whether a resurgence of heroin use among veterans—the likes of which has not been seen since the Vietnam era—was associated with the nonmedical use of yes, prescribed narcotics. The same study found that solely having chronic pain was not correlated with the use of heroin.⁴ This finding offers the hope that practitioners and patients together can learn to treat chronic pain with opioids in selected patients, which can be life-restoring in appropriate cases for limited duration, safely and responsibly while avoiding and minimizing the death dealing blow of opioid use disorders.

In this issue, we also feature a discussion with Karen Drexler, MD, the newly appointed Mental Health Program Director, Addictive Disorders. Dr. Drexler expertly discusses a wide array of SUD subjects relevant to Federal Practitioner readers, including the approach to patients using medical marijuana in the VA, the 2016 VA/DoD Clinical Practice Guidelines, and an inside view of the challenges and successes of VA SUD programs, from the vantage point of the new leader of these critical initiatives.

Finally, astute readers may notice the editorial attempts to avoid use of the value-laden terms addiction and substance abuse. Instead, the less stigmatizing terminology of DSM-5 is employed, which jettisons the problematic abuse and dependence distinction for the unitary domain of SUDs. This approach is not just a change in semantics but as thought leaders have shown, a real and meaningful comprehension of the role of words in shaping culture.⁵ The VA as a health care entity is moving to adopt better scientific framing of SUDs as a salient step toward a recovery-oriented program.

In the coming months, we intend to expand our coverage of this public health crisis, and we invite readers who care every day for patients wrestling with SUDs for control of their health and very lives, to educate, advocate for resources for active-duty service personnel and veterans, and share innovative efforts to turn the tide toward recovery.

August 2016 provided 2 impressive news stories. These stories have far more salience and granularity than I can began to entertain in this brief editorial, but they show that the VA with all its systemic problems has unrivaled potential to promote what Aristotle called human flourishing.

A past director of mine greeted any small success or positive accomplishment of the facility and its employees with the folksy aphorism “You have to celebrate when you can in this outfit.” He was wise, for he knew that taking a respite to recognize a job well done is crucial to the emotional wellness of the workforce. And after that moment of satisfaction, everyone gets back to work at least a little bit recharged. So in this editorial, I will praise a few recent, unique VA achievements that underscore the importance of keeping the organization not only upright, but also doing right.

On August 1, President Obama announced that since 2010 veteran homelessness had been reduced by almost half. VA Secretary Robert A. McDonald also applauded a 56% decrease in unsheltered homeless veterans. Yet just as quickly, he refocused the collaborating agencies on the goal of ending veteran homelessness, which seemed a long shot when initially announced but now seems to have a realistic chance of success. “Although this achievement is noteworthy, we will not rest until every veteran in need is permanently housed,” McDonald said.

Three large government agencies and extensive partnerships cooperated to keep 360,000 veterans and their families from being homeless. But each veteran also had the outreach and support of a HUD-VASH (U.S. Department of Housing and Urban Development and VA Supportive Housing) worker and counterparts in the community. It is hard to see how any other health care organization could leverage this large an effort or would choose to dedicate its federal, state, and city resources to meet a need so basic that without it few persons can move up Maslow’s hierarchy of human actualization.

The same week the VA Research and Development program gave all of us in federal service a reason to hold up our collective heads a little higher announcing that the Million Veteran Program (MVP) had enrolled its 500,000th participant, making it the largest genomic database in the world. Once again, it is difficult to imagine any other health care organization, except another federal agency like the National Institutes of Health, mounting such an ambitious research initiative.

The MVP offers a databank—the likes of which has never been assembled—to study some of the most common and debilitating conditions, such as mental illness, substance use, and kidney and heart disease among many others. The combination of environmental genetics and clinical and psychosocial data will open doors of discoveries for thousands of people, veteran and nonveteran alike. Secretary McDonald applauded the most important ethical aspect of the project, the incomparable altruism of veterans, “Many of our veterans have saved lives on the battlefield and because of their participation in MVP, their participation has the potential to save countless lives—now and for generations to come.”

These 2 amazing initiatives have more in common than may seem apparent at first glance. Besides their intrinsic worth in humanist service and scientific creativity, respectively, putting veterans in homes and constructing a repository of scientific knowledge show that the VA—once accused of being a dinosaur ignoring the plummeting temperatures of its own ice age—has demonstrated remarkable instantiation of the I CARE Core Characteristics of agility and innovation (available at http://www.va.gov/icare) in the campaign to end homelessness and the MVP initiative.

These good-news stories celebrate the immense power of the VA to change the world for the better. This is reason enough to keep the faith that VA will emerge from the hearings and the headlines as a workforce proud of their privilege to care for veterans and contribute to the common good.

August 2016 provided 2 impressive news stories. These stories have far more salience and granularity than I can began to entertain in this brief editorial, but they show that the VA with all its systemic problems has unrivaled potential to promote what Aristotle called human flourishing.

A past director of mine greeted any small success or positive accomplishment of the facility and its employees with the folksy aphorism “You have to celebrate when you can in this outfit.” He was wise, for he knew that taking a respite to recognize a job well done is crucial to the emotional wellness of the workforce. And after that moment of satisfaction, everyone gets back to work at least a little bit recharged. So in this editorial, I will praise a few recent, unique VA achievements that underscore the importance of keeping the organization not only upright, but also doing right.

On August 1, President Obama announced that since 2010 veteran homelessness had been reduced by almost half. VA Secretary Robert A. McDonald also applauded a 56% decrease in unsheltered homeless veterans. Yet just as quickly, he refocused the collaborating agencies on the goal of ending veteran homelessness, which seemed a long shot when initially announced but now seems to have a realistic chance of success. “Although this achievement is noteworthy, we will not rest until every veteran in need is permanently housed,” McDonald said.

Three large government agencies and extensive partnerships cooperated to keep 360,000 veterans and their families from being homeless. But each veteran also had the outreach and support of a HUD-VASH (U.S. Department of Housing and Urban Development and VA Supportive Housing) worker and counterparts in the community. It is hard to see how any other health care organization could leverage this large an effort or would choose to dedicate its federal, state, and city resources to meet a need so basic that without it few persons can move up Maslow’s hierarchy of human actualization.

The same week the VA Research and Development program gave all of us in federal service a reason to hold up our collective heads a little higher announcing that the Million Veteran Program (MVP) had enrolled its 500,000th participant, making it the largest genomic database in the world. Once again, it is difficult to imagine any other health care organization, except another federal agency like the National Institutes of Health, mounting such an ambitious research initiative.

The MVP offers a databank—the likes of which has never been assembled—to study some of the most common and debilitating conditions, such as mental illness, substance use, and kidney and heart disease among many others. The combination of environmental genetics and clinical and psychosocial data will open doors of discoveries for thousands of people, veteran and nonveteran alike. Secretary McDonald applauded the most important ethical aspect of the project, the incomparable altruism of veterans, “Many of our veterans have saved lives on the battlefield and because of their participation in MVP, their participation has the potential to save countless lives—now and for generations to come.”

These 2 amazing initiatives have more in common than may seem apparent at first glance. Besides their intrinsic worth in humanist service and scientific creativity, respectively, putting veterans in homes and constructing a repository of scientific knowledge show that the VA—once accused of being a dinosaur ignoring the plummeting temperatures of its own ice age—has demonstrated remarkable instantiation of the I CARE Core Characteristics of agility and innovation (available at http://www.va.gov/icare) in the campaign to end homelessness and the MVP initiative.

These good-news stories celebrate the immense power of the VA to change the world for the better. This is reason enough to keep the faith that VA will emerge from the hearings and the headlines as a workforce proud of their privilege to care for veterans and contribute to the common good.

August 2016 provided 2 impressive news stories. These stories have far more salience and granularity than I can began to entertain in this brief editorial, but they show that the VA with all its systemic problems has unrivaled potential to promote what Aristotle called human flourishing.

A past director of mine greeted any small success or positive accomplishment of the facility and its employees with the folksy aphorism “You have to celebrate when you can in this outfit.” He was wise, for he knew that taking a respite to recognize a job well done is crucial to the emotional wellness of the workforce. And after that moment of satisfaction, everyone gets back to work at least a little bit recharged. So in this editorial, I will praise a few recent, unique VA achievements that underscore the importance of keeping the organization not only upright, but also doing right.

On August 1, President Obama announced that since 2010 veteran homelessness had been reduced by almost half. VA Secretary Robert A. McDonald also applauded a 56% decrease in unsheltered homeless veterans. Yet just as quickly, he refocused the collaborating agencies on the goal of ending veteran homelessness, which seemed a long shot when initially announced but now seems to have a realistic chance of success. “Although this achievement is noteworthy, we will not rest until every veteran in need is permanently housed,” McDonald said.

Three large government agencies and extensive partnerships cooperated to keep 360,000 veterans and their families from being homeless. But each veteran also had the outreach and support of a HUD-VASH (U.S. Department of Housing and Urban Development and VA Supportive Housing) worker and counterparts in the community. It is hard to see how any other health care organization could leverage this large an effort or would choose to dedicate its federal, state, and city resources to meet a need so basic that without it few persons can move up Maslow’s hierarchy of human actualization.

The same week the VA Research and Development program gave all of us in federal service a reason to hold up our collective heads a little higher announcing that the Million Veteran Program (MVP) had enrolled its 500,000th participant, making it the largest genomic database in the world. Once again, it is difficult to imagine any other health care organization, except another federal agency like the National Institutes of Health, mounting such an ambitious research initiative.

The MVP offers a databank—the likes of which has never been assembled—to study some of the most common and debilitating conditions, such as mental illness, substance use, and kidney and heart disease among many others. The combination of environmental genetics and clinical and psychosocial data will open doors of discoveries for thousands of people, veteran and nonveteran alike. Secretary McDonald applauded the most important ethical aspect of the project, the incomparable altruism of veterans, “Many of our veterans have saved lives on the battlefield and because of their participation in MVP, their participation has the potential to save countless lives—now and for generations to come.”

These 2 amazing initiatives have more in common than may seem apparent at first glance. Besides their intrinsic worth in humanist service and scientific creativity, respectively, putting veterans in homes and constructing a repository of scientific knowledge show that the VA—once accused of being a dinosaur ignoring the plummeting temperatures of its own ice age—has demonstrated remarkable instantiation of the I CARE Core Characteristics of agility and innovation (available at http://www.va.gov/icare) in the campaign to end homelessness and the MVP initiative.

These good-news stories celebrate the immense power of the VA to change the world for the better. This is reason enough to keep the faith that VA will emerge from the hearings and the headlines as a workforce proud of their privilege to care for veterans and contribute to the common good.