Vets

It is easy to make generalizations about the veteran patient population. Most of the patients who present for surgery are over 60, and nearly all of them have hypertension, hyperlipidemia, diabetes, COPD, and arthritis or degenerative joint disease. Looking back through my pre-operative notecards, 90% of them start with "HTN HL DM" as the first line under the past medical history. The veteran population also struggles with substance use; virtually every patient has a smoking and drinking history, many use marijuana, and a good number use illicit drugs. Psychiatric disease and medications are common. Obesity is a big problem; when I'm at the VA, a "normal sized" patient is 90kg (nearly 200lbs) and I don't break a sweat until someone exceeds 120kg (260lbs). All of these characteristics are quite different than the patients I see at Stanford and Valley.

Why is this the case? There may be some positive to take from it - perhaps the VA is so good at primary care that everyone gets plugged into the system and is appropriately diagnosed and treated for hypertension, hyperlipidemia, and diabetes. But perhaps the preventive care does not start early enough; maybe vets could avoid these chronic diseases if they saw a physician earlier. Some service-related conditions like PTSD can exacerbate non-service-related conditions like hypertension. It is important for us to understand why this population is so homogeneous yet different than the community in order for us to address their particular health care needs.