Journal of general internal medicine
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Gulf War illness (GWI) is characterized by multiple, persistent symptoms (e.g., fatigue, musculoskeletal pain, concentration problems, and gastrointestinal disorders) across more than one body system that are severe enough to interfere with daily functioning. For Veterans in rural areas, the confluence of geographic barriers and GWI may create unique challenges when navigating health care, given the range of specialty care needed to support GWI. However, little is known about how rural Veterans manage their GWI symptoms and navigate health care systems. ⋯ Our findings suggest that rurality intersects with GWI management in ways that compound barriers to health care access for Veterans. VA can address time and distance barriers by continuing to expand specialty telehealth services and telehealth training for providers and patients. VA could also incorporate recommendations from the VA/DoD clinical practice guidelines into point-of-care decision support to enhance recognition of GWI and improve consistency of treatment, which may contribute to trust-building among GW Veterans.
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Trainees frequently present data, including vital signs, laboratory test results, and imaging results, just after the history or presenting illness in a section labeled "ED Course." This practice distracts from the history and physical and decenters the patient as the most valuable source of diagnostic data. Reformatting presentations to appropriately present objective data after the complete history may improve diagnosis and refocuses attention on the patient.
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Physicians are estimated to be responsible for more than 50% of national healthcare costs and hold the greatest potential to improve value by orchestrating quality-driven programs to reduce unnecessary practices and variability. A physician's ability to practice cost-conscious care has been linked to their training, underscoring the importance of integrating cost-conscious practice into training. ⋯ Skills and knowledge are significantly improved after completion of our program, demonstrating that a free, web-based curriculum and tiered mentoring program can be effective in teaching HVC skills and preparing physicians to lead this work.