Late Breaking News
Schoomaker Looks Back on Eventful Years as Army Surgeon General
On military suicides:
“Whether we can return to the [suicide] rate we had before or not I think is still in question,” he said. “But I think we can’t help but emerge from this period with a far greater understanding of what this very important segment of the American population is going through and how we might improve upon their resilience and mental health and prevent this very destructive and impulsive behavior.”
Schoomaker said some important efforts on preventing and understanding suicide in the military are taking place, such as the Army Study To Assess Risk and Resilience in Servicemembers, the largest study of mental health risk and resilience ever conducted among military personnel. It “has been compared to both the Framingham Study and Manhattan Project,” he said.
On AHLTA, the military’s electronic medical record:
In 2009, Schoomaker told Congress about the difficulties that providers were having in using AHLTA. The system continues to be “in serious need of major transformation,” he told U.S. Medicine.
“We have seen its improvements, its modifications, its applications, its utilities to the provider as lagging behind what we hoped it would be,” he said. “Whether it be at the point of interface between the patient and the provider when information is imputed and when the provider and patient are looking for the system to deliver integrated messages about what needs to happen to improve the health of that individual patient, to the larger system problems of how do we fully and comprehensively analyze who we are caring for and what their real health challenges are … I don’t think we are nearly where we want to be.
“We know that, because we can compare it to, if not like systems, at least systems that are doing a better job in achieving any one of those [such as] the VA’s VISTA system, which is far more user-friendly at the level of the individual provider and the patient, which is really where we have got to have the best buy-in. If we don’t have providers and patients who have confidence in the electronic medical record, then we will not get entry to achieving what we really want to do, which is to improve overall outcomes and health in general. …We have a long way to go, but we have a lot of people who are working very, very hard, and we have applied some of our best minds to this.”
On what worries him about a leaner military:
“I am worried about a generation of soldiers, sailors, airmen, marines, Coast Guardsmen and their families who have spent the last 10 years and continue to this day to fight a difficult set of wars and respond to humanitarian crises and contingency operations around the world and whose physical and emotional injuries are going to [need] time to fully heal, from which they need to recover, and support from the system,” he said. “We have a history of quickly changing to the next major challenge or topic and then forgetting the obligation we have to best serve these people. The overall healing and recovery and reintegration of our warriors and our families will take time, well beyond the drawdown, and I worry about that.”
Schoomaker also emphasized the need to maintain a robust direct healthcare system.
“Without a robust healthcare system of uniform medical centers, community hospitals, health centers, public-health capabilities of laboratories and agencies that are doing the array of things that we have right now, we can’t recruit, retain and continue to improve upon the care that is being delivered. It isn’t by chance that people have done as well as they have in combat operations or contingency operations providing care in the battlefield. That doesn’t happen overnight, but through almost daily live-fire exercises, as I tell my counterparts in the combat arms, within our hospitals and health centers and clinics. We have got to maintain our capability to do that. That is what readiness is about. I do worry about that. And I worry that someone or some consortium will look at the military healthcare system as an attractive means by which they can extract a one-time efficiency that in the long run will put the force at risk.”
If he has one regret, Schoomaker said, it was that military leadership did not recognize early in the war the need to enforce mandatory screening on the battlefield for possible concussive events, so that these injuries could be caught as soon after the injury as possible. In 2010, DoD guidelines were put in place that outlined scenarios in which mandatory medical screening for mTBI must be conducted in theater.
“If I regret anything, it is failing to recognize that [mandatory screening] had to be enforced … and the only way to do that is to engage the war-fighting leadership community to make that happen. Turning off the spigot of recurrent-concussive injuries, I think, is going to prove to be absolutely essential for the long-term health of the force and to reduce the overall burden of these blast injuries.”
On being a patient himself:
In 1980, Schoomaker was diagnosed with carcinoma. “Given that we, as caregivers, are a part of the larger human family, subject to all of these frailties, nothing makes you a better caregiver than having experienced an injury or an illness,” he said. “It has given me great sympathy for what our patients experience.”