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as to allow him or her to express all of the patient's reasons for seeking care, including symptoms, feelings, thoughts, and expectations. Patient-centered care requires positive interaction or communication between the patient and the physician, interaction during which the physician actively seeks the patient's point of view.

Owens et al. (1995) studied the effect of physician-patient interaction on the long-term prognoses of patients with irritable bowel syndrome. They found that a positive physician-patient interaction may be related to reduced use of ambulatory health services by such patients. Daltroy (1993) studied the effect of doctor-patient communication on patients with rheumatological disorders. He found that effective communication results in increases in patient knowledge, in desirable behaviors (especially compliance with prescribed treatments), in self-confidence, and in functional status.

A review of the literature by Ong et al. (1995) reported that information giving, time spent in discussion of preventive care by the doctor, and greater interview length were positively associated with patient satisfaction while a dominant, controlling style of communication on the part of the physician produced less satisfaction. They also found that in the ideal medical interview the patient leads in areas where he or she is the expert (symptoms, preferences, concerns) and the physician leads in his or her domain of expertise (details of disease, treatment).

Stewart (1984) found that physician behavior is crucial and that a positive outcome depends on physician behavior that is facilitating rather than dominating. Kaplan et al. (1989) found that better health status was related to more patient and less physician control, more affect (i.e., expression of both positive and negative emotions) expressed by physician and patient, and more information provided by the physician in response to effective patient information seeking.

In following this patient-centered approach to care, physician questions should be asked in a manner that conveys genuine interest and does not make the patient feel that he or she is under interrogation. Once rapport is established, questions can become more detailed or specific, focusing on the patient's problems, blending open-ended questions with others that can be answered easily with a yes or no.

The goal of evaluation is to define the problem that the patient identifies with Gulf War deployment through relatively nonintrusive inquiries about the patient's problems and symptoms, only then moving on to more specific questions. Patients may need reassurance before disclosing their thoughts and behaviors; clinicians should reassure them about the confidential nature of the doctor-patient relationship. Family members and friends can be important informants, able to fill in the gaps in the patient's history or to describe behaviors they may have witnessed. Pa



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