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HEIDELBERG, Germany — Even as the U.S. Army health care system continues to downsize in Europe, its beneficiaries should be hearing more often from U.S. clinic doctors and nurses about sometimes uncomfortable but necessary procedures, said the European Regional Medical Command commander.

Brig. Gen. Keith Gallagher, who arrived in January, said he has begun a push to make U.S. military facilities — which despite the downsizing will still be providing primary care to soldiers and family members — more actively communicate with patients about preventive care and managing chronic diseases.

“We’re not doing it as we should be. We recognize it as a problem,” Gallagher said. “I want to improve the health status of Tricare Prime beneficiaries in Europe.”

He said that means being more attentive to clinical practice guidelines for managing chronic diseases — with necessary tests and follow-up at the appropriate intervals — so that people with diabetes or heart disease, for example, do not get worse.

It also means increasing attention to preventive medicine, he said — including mammograms, colorectal screening, Pap tests, blood tests — and having clinic staff reach out to patients when it’s time for such a test.

“It’s contacting the servicemembers or family members — ‘Hey, you’re 50; you need to get a colorectal screening,’” Gallagher said.

Gallagher did the same at his last command, at Blanchfield Army Community Hospital, Fort Campbell, Ky., he said, because it’s smart medicine that prevents needless deaths. “My mom died of cervical cancer,” Gallagher said. “That’s preventable.”

Gallagher also has emphasized that his medical staffs, no matter how stretched, are sensitive to patients’ needs. At Blanchfield, he asked the staff to sign a statement espousing excellent patient care.

“I want you (medical staffers) to look patients in the eye, and get them to smile,” he said. “Folks are troubled. They have deployed spouses.

“The second thing is, when you’re done with that encounter, I want them to ask, ‘Is there anything else I can do for you? I have the time.’ We’ve got folks who are dealing with a lot,” Gallagher said.

But ERMC’s medical staffs are smaller than they once were, with hospitals and clinics closing in the past few years.

At Darmstadt, one of three communities whose clinics are scheduled to close this summer, appointments for retirees and Defense Department civilians were canceled because of the unexpected deployment of a doctor there. Mannheim’s clinic recently asked for people’ patience after four of the usual 10 doctors there had left and two more were leaving in June.

ERMC recently said that in the summer, when military doctors change assignments and take leave, most clinics are short-staffed.

And the absence of even one doctor can cause chaos in the appointment schedule when staffs are small to start with. “When one doctor out of three doesn’t show up, that means that one-third of the appointments are not being covered,” Gallagher said.

Staff downsizing has already begun in Heidelberg, whose half-century of providing a military hospital ends in a few weeks when the hospital becomes a health center, without capability for maternity, emergency or inpatient surgery.

That means that the care will be provided by local German doctors. Gallagher is planning an information campaign to help Americans feel more comfortable with the German system — with virtual tours of local facilities, fliers, and even refrigerator magnets to familiarize people.

“Trying to instill confidence in the German health care system,” he said. “It’s pretty darn good.”

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