Battling PTSD: A GP and patient perspective
Dr Phil Parker explores the effect of PTSD on patients and their families, and we hear from Vietnam veteran and PTSD sufferer Richard who explains the importance of a good support network when battling with PTSD
Today, I’m committed to supporting the health of military veterans as they endeavour to establish new lives outside the Australian Defence Force (ADF). It is so important for general practitioners to understand the needs of PTSD sufferers, to be aware of the resources available for these patients and their families and to provide effective avenues to seek specialised treatment. Gallipoli Medical Research Foundation’s recent three-year study, supported by RSL (Queensland Branch), involving 300 Vietnam veterans examined relationships between physical illnesses like heart disease, gastric complaints and sleep disorders and the psychological symptoms of PTSD. From the study findings published in the Medical Journal of Australia we know that PTSD impacts various body systems, however particular attention should be paid to sleep and gastric complaints. Any time a patient reveals a history of previous military service should alert a general practitioner to the likelihood of multiple medical conditions including PTSD. General practitioners should enquire about sleep disturbances, frequency of nightmares and any disturbances of mood. Many veterans will often present with other conditions during an initial consultation with their general practitioner. Patients will often assess whether they can engage with the doctor before revealing their mental health issues. Trust is essential. Other conditions experienced by veterans are quite similar to the general population, but there will be a greater number of patients with musculoskeletal issues. Common conditions include chronic back pain and other joint conditions. Some may also suffer chronic pain conditions. In fact, PTSD suffers are: • almost four times more likely to have suffered a heart attack in the past • two to three times increased risk of suffering from gastrointestinal problems including irritable bowel syndrome and its associated symptoms, in addition to reflux and stomach ulcers • two times more likely to have abnormal liver texture, suggestive of liver disease • four times higher risk of fatty liver • most likely to exhibit decreased lung function • three times more likely to suffer from obstructive sleep apnoea It is so important general practitioners demonstrate a willingness to commit to the care of PTSD patients and their families. They should understand that PTSD will rarely be the only condition suffered by the individual and be willing to provide holistic care for all conditions. It is important to also ask about the general health and wellbeing of family members providing support to the PTSD sufferer. The importance of the support network for any PTSD sufferer cannot be understated. Families quite often have to endure the negative effects of PTSD for some years. They tolerate mood disturbances including irritability and low mood. Through all of this, they remain the stable foundation for the patient. It is critical for the general practitioner to consider involving partners in the development and ongoing management of patient treatment plans. Take Richard, a Vietnam veteran and participant in the study for example. Diagnosed with PTSD in 1995, Richard has suffered from severe depression, attempted suicide, anxiety attacks, social dysfunction and phobias. He describes his personal experience with PTSD and how it manifested in his everyday life: ‘’I got into a very depressed state, a lot of anxiety. The hypervigilance, the hiding behind windows in my own home, looking at places I can escape to if we were ever attacked, those types of things’’. He further explains the importance of a good support network when battling with PTSD: ‘’PTSD is a very selfish condition; you cannot think of anything else but yourself, whether you want to or not. It's very difficult to come and talk to strangers; even your local doctor who you might have gone to for years, but you still have trouble with that because there's still that stigma to mental health. It's been important in my situation to have a very supportive and understanding partner beside me. We all need effective and informed support’’.
Once a relatively unknown condition, many Australians now understand that PTSD is a condition suffered by individuals employed in roles where their safety is put at risk. Acceptance of PTSD by the general population as a ‘real’ condition and a significant social cost to the country is growing. This, and increased media attention instils confidence amongst sufferers that medical treatment is available, accessible, and encouraged. As health professionals we have a big part to play in fostering this confidence.
Dr Phil Parker
General practitioner in the Brisbane suburb of Newstead. Dr Phil began his career in 1988 with the Royal Australian Signals corps. In 2005 he commenced medical studies at the University of Queensland before serving at Fremantle Hospital for two years. In 2011 Phil returned to the Army as a medical officer and in 2012 was deployed to Afghanistan as the task force surgeon. Dr Phil was awarded his general practice fellowship in 2014 and transitioned to full-time community general practice in late 2015. He is committed to supporting the health of military veterans as they endeavour to establish new lives outside the ADF.