Australian general practitioners (GPs) are central to the provision of healthcare for more than 600,000 ex-serving members of the Australian Defence Force (ADF).1 GPs may also be required to provide health services to the approximately 60,000 permanent ADF members and 39,000 members in the reserve force, in civilian and military settings.2 ADF serving members may also choose to visit a GP for additional health services.
The primary healthcare needs of serving and ex-serving ADF members include the same health needs of comparable non-serving populations. These include occupational medicine, prevention and treatment of musculoskeletal conditions, mental health and substance abuse, chronic pain and Aboriginal and Torres Strait Islander health. Three per cent of currently serving ADF members are Aboriginal and Torres Strait Islander peoples, making the ADF one of Australia’s largest employers of Aboriginal and Torres Strait Islander peoples.3 The health needs of serving and ex-serving ADF members may also include those specific to military service (eg aviation and underwater medicine). There are also significant numbers of Commonwealth and other nations’ ex-service personnel who have migrated to Australia who may present with similar issues. Family members of serving and ex-serving members also face some particular health issues that may differ from the civilian population.4
Military systems have been historically male-oriented, resulting in a systemic under-representation of women’s health issues in military medicine, research and development. Factors contributing to female-specific health issues for ADF members include training strategies, operations, human factors (eg body size) and personal protective equipment. 5,6 GPs need to take these factors into account when assessing and managing serving and ex-serving female ADF members.
Serving ADF members are accustomed to accessing ADF healthcare services, but after discharge, often lack experience in managing their own health. They may not have learnt how to navigate the Australian civilian health system and may be unaware of specialist service access, wait times and out-of-pocket costs of care as their health literacy skills may be underdeveloped.7 GPs are in an ideal position to assist ex-serving members to fully re-engage with the civilian primary healthcare system and Department of Veterans’ Affairs (DVA) services.
GPs also need to be attuned to the specific healthcare needs of ex-serving members, recognising that around 12% of all ADF discharges are due to medical conditions that preclude service in a military environment.8 Following discharge, there is often a significant worsening of mental health symptoms in some ex-serving members a few years after leaving military service. A lack of social support due to frequent moves associated with military service and difficulties maintaining intimate family relationships from prolonged deployment, service at sea or training activity separations, may aggravate these mental health problems.7 GPs should aim for early identification of physical and mental health conditions through appropriate and sensitive history-taking.