Highlights From Residents’ Journal: June 2020

The military psychiatrist faces some unique ethical conundrums about which they must maintain constant awareness, while remaining vigilant of the rights of the patient and the need to uphold the principles of autonomy, beneficence, nonmaleficence, justice, veracity, and fidelity. Many psychiatrists never face ethical conflicts associated with military service, but awareness of them enables all psychiatrists to provide better care to patients connected with the military.

This article explores the unique advantages of behavioral healthcare in the United States Army from a biopsychosocial perspective. Numerous initiatives emphasize prevention through ongoing screening and maintenance of physical and behavioral health. Access to care is improved due to no out-of-pocket costs, high resource commitment to behavioral health services, and fewer insurance limitations. Continuity of care is established worldwide through a universal electronic health record. Providers face minimal utilization management pressures and can prescribe occupational interventions that are unavailable in civilian practice. The distinguishing features of Army behavioral healthcare may provide a framework for analogous initiatives in civilian health systems.

Medical practice reflects the spirit of the clinician, influenced by mentors, institutional pressures, and academic zeitgeist. Psychiatry carries unique responsibility to cognize how patients merge their sense of self in values, struggles, and goals. Comprehensively grasping the interplay between person and impairment requires more than openhearted patience. Subcultures of psychiatry might be particularly influenced by life experience. Specifically, non-medical experience, such as combat service prior to entering the medical profession, inherently shapes patient care. Exceptional heroism aside, the common experiences of ground troops are exquisitely dissimilar from those of psychiatric residents and clinicians.