Military MDs know where their duty lies
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* Lieutenant Peramaki

While I applaud Heather Kent for bringing the problem of post-traumatic stress disorder in members of the Canadian Forces into public view,1 one of the statements in her article disturbed me. Psychologist Marvin Westwood suggests that military physicians are obliged to report psychological symptoms.1 This is simply not the case. The principle of patient–physician confidentiality applies for both military and civilian physicians. I am not allowed to report diagnoses to the superiors of a member of the Canadian Forces; all I am obliged to report are occupational restrictions relating to a member's illness.

If someone was suspected of suffering from or was diagnosed with post-traumatic stress disorder, they would likely be at least temporarily restricted from participating in other peacekeeping missions. The Canadian Forces would also ensure access to specialist medical and psychological assessment or treatment. Although some may fear career repercussions from a temporary inability to serve overseas, it is surely more important to prevent further potentially traumatic exposures to the realities of modern peacekeeping. “First, do no harm” is a tenet we take very seriously. Further, a diagnosis of post-traumatic stress disorder does not mandate release from the Canadian Forces. The decision to release or retain a member is based solely on his or her functionality; diagnoses are not revealed or considered.

I hope that physicians encountering members of the Canadian Forces who may have post-traumatic stress disorder do not leave military physicians uninvolved in the care of these patients. We have resources such as regional occupational trauma stress support centres that can provide expert and expedient help. And please do not contribute to any unfounded suspicions about where our duty lies. As physicians, it rests with the interests of our patients.

## Reference

1.  1. Kent H. BC physicians help peacekeepers fight their demons. CMAJ 2000;163(9):1183.
    
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