The number of military personnel has shrunk by more than half from levels 50 years ago.¹ According to 2010 data, today’s military consists of fewer than 2.3 million troops.¹ A 2013 New York Times editorial² took the data a step further, highlighting that less than 0.5% of the US population serves in the military, and many of those service members come from military families. The all-volunteer nature of our military has led to a subculture of those who serve, making our military yet another face of diversity. As physicians, we must strive for greater understanding of the unique aspects that weigh heavily in the healing of these patients and their communities. 

The current issue of The Journal of the American Osteopathic Association includes 2 articles that report on the effect of physician practice patterns and comfort level in managing the health of active-duty military and veteran populations. In their article “Relationships Between Polypharmacy and the Sleep Cycle Among Active-Duty Service Members,” Lande and Gragnani,³ from the Psychiatry Continuity Service at Walter Reed National Military Medical Center in Bethesda, Maryland, report on the impact of commonly prescribed medications for depression and sleep problems on the sleep architecture of active-duty military personnel as measured by self-reported insomnia rating scales and home sleep studies. Their data and conclusions shed light on potential iatrogenic causes for the pervasive nature of insomnia. They did not restrict their understanding of insomnia to polypharmacy but to the social and emotional issues related to military service and deployments. Medication use requires monitoring for the expected outcome—if that outcome is not achieved, a different approach is warranted. Therefore, the authors³ call for alternative therapies that have fewer adverse effects to restore health and well-being. A combined treatment approach of communication skills, psychotherapy, systems-based thinking, and osteopathic whole patient care principles, with a focus on health restoration rather than symptom suppression, expands our armamentarium and certainly is the health platform for the future. 

In “Perceptions of Physicians in Civilian Medical Practice on Veterans’ Issues Related to Health Care,” Fredricks and Nakazawa,⁴ from the Ohio University Heritage College of Osteopathic Medicine at Athens, report on a survey of civilian physicians’ familiarity with and comfort in addressing veterans’ health problems. Their data suggest the need for more research in this area, as well as education for civilian physicians to ensure that they are well prepared to treat this patient population. Their study⁴ reconfirms that physicians and other health care providers need to apply systems-based practices and interprofessional communication skills to coordinate care in the treatment of veterans and civilians alike. 

Both of these articles^3,4 relate to the attitudes, cultural insight, holistic thinking, and treatment of active-duty service members and veterans by practicing primary care physicians and psychiatrists. They also illustrate an important and necessary trend in the diversification of physician research to include findings that embrace many of the 7 core competencies in osteopathic residency training.⁵ A greater emphasis on the full spectrum of competencies, not just medical knowledge, is needed.