​

Cheryl Martin (Host): This is Community Connect presented by Tampa General Hospital. I'm Cheryl Martin. Joining me this episode is Dr.Yamil Miranda, the Medical Director of Primary Care at Tampa General Medical Group at Tampa General Hospital. He's a Board Certified Family Medicine physician and US Air Force veteran. With a background in military medicine and clinic leadership, he helped launch the military and veterans primary care, MVP Center, the first of its kind in the Tampa Bay region. Dr. Miranda, welcome. So glad to have you on.

Yamil Miranda, MD: Thank you so much Cheryl. Glad to be on.

Host: So let's begin with primary care as prevention. How does primary care support early detection and management of chronic conditions?

Yamil Miranda, MD: So primary care oftentimes is where patients are seen first in the healthcare system or where they seek care. So it's a doorway basically into healthcare. And in regards to the management of chronic conditions, how we manage chronic conditions is with prevention. And that's one of our bigger focus areas in primary care.

Host: So why is it so important to establish care with a primary provider even when you feel healthy?

Yamil Miranda, MD: In order to successfully navigate the healthcare landscape in which we live, it is important to develop a trusting relationship and oftentimes patients will be able to develop that with a primary care provider. As we see patients longitudinally over time, we're able to gain their trust, they're able to feel free to tell us things that will help with their overall health.

Host: So. Do you approach care differently for civilians versus veterans? And if so, how?

Yamil Miranda, MD: Sure there are some differences. You know, in our veteran population, we are looking for things as exposures perhaps to different chemicals. We're also paying close attention to history of trauma, combat related trauma, sexual trauma, probably more closer than in the general population. So there's a little bit of a difference.

But also other things that we see in the civilian population apply to the veteran population, such as prevention of chronic diseases.

Host: You mentioned earlier that you really focus on prevention and when I asked how does primary care support early detection and management? So are there some general principles that you give patients if they are healthy, that you say, Hey, this is how we can be preventive?

Yamil Miranda, MD: Sure. So even if we're healthy, o ne of the biggest things is to be checked out with your physician or by your physician at least on an annual basis. That allows us to track things like your weight, your blood pressure, looking at your mental health by screening you for things like depression and anxiety and checking for other things like your blood sugars, your cholesterol.

So a lot of times chronic diseases start asymptomatic, right. So you might be feeling great, but you might be on your way to develop a chronic disease that if we find early, we can be more successful in treating it or preventing it.

Host: Great. Now I want to focus on culturally competent care for veterans. What do you see as some common health trends or concerns in military affiliated patients?

Yamil Miranda, MD: So in our military affiliated population, we are oftentimes screening for, like I said before, exposure to toxins, right? So we have people that were deployed or were in combat situations in Iraq and Afghanistan that were probably exposed to burn pits. We have people that work on nuclear submarines, for example.

We also have a lot of musculoskeletal issues in our veteran population. A lot of back pain, a lot of knee pain, a lot of hip pain, arthritis. So those things differ, in our veteran population or health threats I should say, that we see in our military affiliated population.

Host: So how does military culture, in your opinion, shape how veterans approach healthcare or avoid it even?

Yamil Miranda, MD: I was a physician in the Air Force, so I used to see a lot of avoidance, sometimes from our troops that are on flying status or combat status, for example, because they don't want to be disqualified from their jobs.

So a lot of times when we see these patients after they leave the military, we uncover a lot of chronic conditions on basically a quote unquote healthy patient.

So there has been a lot of avoidance, for years in that culture. But it's great to see them after they are done with their military service and now they're ready to address their healthcare. Right. It might be a little challenging. And we have to do our best to try to break that up and not overwhelm the patient or the system. But it's very satisfying.

Host: What training or approaches has your clinic adopted to meet the specific needs of this population?

Yamil Miranda, MD: So we have obtained some training in regards to military culture from some partners that we work with. For example, Home Base, which is a H Healthcare Veterans Initiative. Also we have staffed our clinic mostly with veterans or providers, personnel that are related to the military culture.

So I am a veteran myself, my physician assistant is a veteran, our nurse navigator is a veteran. And then we have other personnel who were raised in the military households. So their parents were both in the military. That has allowed us to make that connection with the veterans or military patient easier.

They feel that we're more relatable to them. They can tell us things and we're going to understand where they're coming from basically.

Host: That's great. So in our remaining time, I want to switch gears and talk about what patients should be asking, but often don't. For example, what would you say are the most important but overlooked questions patients should be asking during visits?

Yamil Miranda, MD: So I do get a question a lot of times, which is, how can I get screened for cancer, for example? We know that is a concern, a public health concern for a lot of people. And the biggest thing is to have our age appropriate screenings completed. Meaning, getting screened for breast cancer, getting screened for cervical cancer, getting screened for colon cancer, not forgetting about skin cancer, right?

Which in a state like Florida, it's a big thing. We do have a lot of patients with skin cancer and also asking the question of, of how can I stay healthy? I don't have that asked to me often. Right. It's usually how can I deal with this disease or that disease, but just asking questions about how should I be eating, how much should I be exercising?

Or what kind of things should I worry about if they were to happen to me, that might indicate a more serious problem?

Host: Now, are there symptoms that people ignore that really should be checked out?

Yamil Miranda, MD: Yeah, so a lot of times, talking about skin, for example, people come in when they have a scab or a lesion on their skin that hasn't healed for years. So initially would be better to get that looked at immediately. We have people with unintended weight loss. Fatigue, bloody stools. So there's a lot of that. And what can I say? If you have any questions, go out to see your primary care doctor. Sometimes you might think it's a silly question, but it might not be a silly question.

Host: No question is silly when it comes to your health. Right.

Yamil Miranda, MD: Absolutely. There's no silly question. You'd be surprised with some of the questions that patients thinks are silly and they actually are very helpful.

Host: Any other advice you give patients to better advocate for their own health?

Yamil Miranda, MD: Absolutely. So, I always say know your body right. Pay attention to those changes. Get comfortable looking at your body. You know, looking between your fingers, looking between your toes. Look at yourself in the mirror. When you go to the bathroom, pay attention to see if there's any unusual things like your bowel movements, for example.

And always in healthcare, if you're not satisfied with an opinion you're getting, get a second opinion. We don't get hurt when people say, Hey Doc, I appreciate that, but can I talk to someone else? My answer is always going to be yes. Right? Because I do want my patients to make the most informed decisions that they can make.

Host: Dr. Yamil Miranda, thank you so much for sharing your expertise and you have offered some great advice for patients. Thank you.

Yamil Miranda, MD: You are very welcome.

Host: For more information on the military and veterans primary care center and other military and veteran services at tgh, please visit tg.org/homebase. Now if you liked this episode, please follow Community Connect presented by TGH on your favorite podcast platform.

This is Community Connect, presented by TGH. Thanks for listening.