I had the honor of welcoming Li-Hua Peng, MD, to the Drossman Center for the Education and Practice of Biopsychosocial Care in Chapel Hill, North Carolina where she worked in my clinic alongside me and my care team for three-weeks as part of the Rome Foundation-China Collaboration. Dr. Peng is a prominent gastroenterologist and associate chief physician at the Chinese People’s Liberation Army General Hospital in Beijing, one of the largest hospitals in the world. She works closely with Yunshang Yang, MD, who is the President of the Chinese Society of Gastroenterology as well as the head of the GI group at the People’s Liberation Army Hospital. Both are committed to learning more about functional GI disorders and educating healthcare providers in China about these GI disorders since this area of gastroenterology is not well taught in China. As part of an important Rome Foundation initiative with China, I am developing collaborations for training Dr. Yang’s physicians through the Rome Foundation where I serve as president.
With special interest in functional gastrointestinal disorders and motility, Dr. Peng has been a gastroenterologist for 18 years. She came to my clinic so she could gain first-hand experience treating patients with in functional GI disorders using a biopsychosocial approach, which is the cornerstone of my practice.
“With so many patients in China, physicians do not have enough time to talk with them the way we to need to truly understand what is going on with them. We can only spend 5-10 minutes with each one, and we spend the short time we have with them to treat them for the presenting symptoms,” said Dr. Peng. “Our main challenge is overcoming the difficulty in communicating with patients effectively in such a short time. As a doctor in China, we need help with this major challenge.”
Dr. Peng noted that the prevalence of functional GI disorders is increasing in China—making the need for effective physician-patient communications a pressing one.
“One reason for the increase is due to the increasing pace of life in China. With the continued advances in technology —the pace of life is very fast in China and much more stressful than it was years ago so the prevalence of functional GI disorders here is also increasing , “ said Dr Peng. “Another reason is that physicians are able to better and more accurately diagnose their patients with a functional gastrointestinal disorder than we were able to do 10 years ago using the Rome Criteria, which has been translated into Chinese. Before that we typically diagnosed these patients with dyspepsia or some type of neurosis.”
According to Dr. Peng, typical treatment is very similar to what physicians do here in the United States, with first line therapy often a lifestyle modification aimed at reducing stress levels and making appropriate dietary changes such as lowering fat intake or increasing fiber in the diet depending on what works best for the patient and basically advising them to avoid problem foods.
“We do use some medications to treat GI symptoms such as antidiarrheals or antispasmoidics medications. However, in China we haven’t used antidepressants, as these types of medications are not so common in the treatment of functional GI disorders, so we don’t use them. Again, our first-line of treatment is recommending that our patients slow down their pace of life.”
Dr. Peng noted that she came to the Drossman Center to “learn how to better manage refractory functional gastrointestinal disorders, including how to talk with patients more efficiently in the short time I have with them and also to learn how and when to use psychotropic medications in treating functional GI disorders. I came specifically to learn from Dr. Drossman. I knew about his work in this area and that his clinic was very patient centric.”
As a medical professional in China, where time is so limited, Dr. Peng said she needs to learn how to pay more attention to and understand how to interpret her patients’ body language and other cues, such as eye contact (or lack of) in order to better understand their unique medical needs—and treat them effectively.
“I came to here because I wanted to learn more efficient ways to communicate with my patients and also help educate my colleagues when I return home. In China we spend such little time with each patient—so communication skills are very important–eye contact, body language can tell us a lot about a patient.”
I was grateful when Dr. Peng called my approach to patients a “careful one.”
“Dr. Drossman and his team pay more attention to patients thoughts and how they are feeling and what is going on in their lives to help determine the connections with the presenting symptoms—and to design the most effective treatment plan individualized for that patient–something we don’t do in China.”
During our time together, I learned that Dr. Peng was particularly interested in the use of antidepressants and other psychotropic medications to treat functional GI disorders, something she said are not used very often in China to treat FGIDS.
“Just a few of the gastroenterologists in China have used them– so after I learn from my experience here, I plan to conduct research in this area. Any refractory functional gastrointestinal disorder is very difficult to treat—that’s why we need to do more research in China to obtain data and experience. But unfortunately we are faced with cost and time limitations—we already do all of our paperwork at night, for example.”
As Dr. Peng finished up her time at the Drossman Center, I asked her if she thought she would be able to do things differently with her patients back in China. “I will be able to things a lot differently,” she said.
“Before my time here, I used to speak to each of my patients for several minutes –yet my time with them never seemed enough to get a full understanding of them in relation to their symptoms. While it will still be difficult for me to spend as much time with my patients in China as I did alongside Dr. Drossman and his patients, I am confident that although I may only have ten minutes, those ten minutes will be much more efficient, allowing me to get more information from my communications with the patient.”
Dr. Peng also said she that she noticed that patient education is very good in the United States remarking on the many resources and brochures available to patients.
“I also plan to train my colleagues about the need for patient education resources so we can better inform our patients.”
One of the most profound insights I learned from Dr. Peng was that China needs more gastroenterologists focused on functional gastrointestinal disorders.
“Most of them like to perform endoscopy and not enough are focused on functional GI disorders,” she explained. “The prevalence of gastroenterologists in China is very high—yet not enough of them are focusing on the psychosocial aspects of functional GI disorders so they can give these patients the insight and advice these patients need to help them modify their lifestyle and address other factors, such as diet and stress reduction in order to alleviate their symptoms and help them feel better.”
The main thing Dr. Peng said she learned from her time with us at the Drossman Center is that “no matter how much time you have—the quality of the interaction can be improved—when you are seeing someone talk to them directly.”
“Although I cannot increase the amount of time I can spend with my patients, I can maximize the time I spend with them by using what I have learned from Dr. Drossman, which include how to deal with resistance from patients. Eye contact and body language are such powerful tools and very useful in communicating with patients—I cannot wait to go back to my practice and implement these new skills.”
About the Rome Foundation’s Role in China
I’m proud to say that over the last 2-3 years the Rome Foundation has introduced a major initiative to expand their global educational and research activities including the Rome IV project with Latin America, Eastern Europe and Asia. With regard to Asia, the Rome Foundation is pleased to have Meiyun Ke MD (China) join the International Liaison Group to help promote educational activities and serve as a liaison to the Rome Foundation from this geographical area. We are excited about educating Chinese doctors on functional gastrointestinal disorders (FGIDs) so they may better serve their patients.
In addition, the Rome Foundation has created an Asian Committee for FGIDs (Chair, Kok An Gwee, Singapore, co-chair Bill Whitehead, USA) which is seeking to understand symptoms from the Asian perspective. This information will be incorporate into the Rome IV committee work. A working team committee has also been established to look at cross cultural research (Ami Sperber, chair) which includes members Shin Fukudo (Japan) and Minhu Chen (China). For Rome IV, there will be a chapter on Multi-cultural Aspects of FGIDs (Chair Ami Sperber, Israel, co-chair Carlos Francisconi, Brazil) with Xiuicai Fang (China) as a member, and also a Questionnaire committee seeking to validate the Rome IV criteria in several languages (Bill Whitehead, USA Chair) which includes Yunsheng Yang (China).
About the Drossman Center for the Education and Practice of Biopsychosocial Care
The Drossman Center for the Education and Practice of Biopsychosocial Care (DrossmanCare) is focused on improving healthcare by improving doctor-patient communications. Improving these communications is shown to improve healthcare outcomes for both patient and doctor, according to founder Douglas A. Drossman, MD, MACG. With the DrossmanCare training, doctors, physician assistants, and nurses can learn how to communicate with patients for maximum benefit, increasing the satisfaction and outcomes of all parties. Dr. Drossman has welcomed healthcare providers from all over the world to his clinic, which features a hands-on, immersion approach. Visit drossmancenter.com for more information.
Douglas A. Drossman, MD