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brief physical exam at each visit, the physician seeking signs of disease rather than taking symptoms at face value; the physician avoiding hospitalization of the patient and minimizing the use of diagnostic procedures, surgery, and laboratory evaluations; and the physician viewing the development of symptoms as an unconscious process, rather than being “all in your head.” Use of this management approach lowered annual medical care costs and improved physical functioning for the subjects (Smith et al. 1990). Following this patient-centered approach to medicine, one can then proceed to implement validated treatments for specific conditions.


The committee recommends that the VA provide specific training to health care providers caring for Gulf War veterans to ensure that they are skilled in the principles and practice of patient-centered care.

Further, the committee recommends that the VA ensure that health care practitioners serving Gulf War veterans are allowed sufficient time with patients to provide patient-centered care.

The preceding pages describe an approach to patient care that can be used regardless of diagnosis or condition. Chapter 5 will explore condition-specific treatments.

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