Five Things Patients with Disorders Involving Brain-Gut Interaction Need to Know About Effective Doctor-Patient Communications April 2018
Functional gastrointestinal disorders, what we are now calling disorders of gut-brain interaction, are especially challenging to manage as patients often struggle to explain their condition during an office visit. I’m committed to continuously empowering patients with insight and tips so they can develop and nurture an effective relationship with their doctor. One of the ways patients can foster a better relationship is by taking steps to make the most out of their doctor visit, especially if they are suffering from chronic GI symptoms, like abdominal pain, diarrhea or constipation.
Here are five things patients need to know:
- Often patients dismiss, overlook, forget or are too embarrassed to share and describe all of their symptoms to the doctor or his staff.
From my practice experience patients have many concerns that evolve from their experiences with their GI disorder and their health care providers but are reluctant to discuss them. Here are some statements that they have mentioned to me.
- “Doctor’s don’t believe me”
- “There MUST be something wrong”
- “I know it’s real”
- “I just want you to open me up and find out the problem”
- “You don’t think it’s in my head, do you?”
- “Sometimes I feel like I’m going crazy
- “Nobody really knows what I’m going through”
- “I feel like I’m not the person I used to be”
- “I feel so alone with this”
- “I feel like such a burden to my family”
- “I have no control over this”
- “ I feel I may have caused some damage”
- “I feel like a failure”
- “I feel ashamed”
- Realities of FGIDs –And Why Patients Need to Understand What They Have
Even though they are not defined by x-ray or endoscopy and exist as dysregulation of neuroenteric functioning and altered mucosal immune function, disorders involving the brain-gut interaction, like IBS, are REAL medical conditions. Despite common misperception, stress doesn’t alone cause FGIDs, but is an enabling factor as for all illness and disease. Efforts to understand FGIDs involve research in brain-gut interactions and to improve patient care involve using a biopsychosocial model.
These FGIDs or brain-gut disorders of altered gastrointestinal function (dysfunction) are attributed to any combination of:
- Motility abnormalities
- Visceral or central hypersensitivity
- Altered mucosal immune function
- Altered gut bacteria composition
- Brain-gut dysregulation
It is vital that patients understand that FGIDs are neither related solely to the GI tract, nor solely to the mind. They involve both the mind and the body; this fine coordinating system of the brain – gut axis is not regulated properly. The basis for these symptoms and their impact on daily life must be understood by patients and their doctors. Patients should not feel embarrassed about sharing this information with their healthcare provider.
- Going to the Doctor: What do you expect in an effective -patient-provider relationship?
Patients should expect that their doctor work with them to identify concerns; explain basis for symptoms; reassure them about their health concerns, management and outcomes; provide a cost-effective evaluation; involve the patient in decisions about treatment and ongoing management; provide continuity of care; and set realistic limits.
Here are the signs of effective physician-patient communications:
- Doctor provides clear information
- Mutually agreed upon goals
- Active role for patients
- Doctor provides positive effect, empathy, support
Ineffective comments by a healthcare provider include:
- “Don’t worry; it’s nothing serious.”
- “I’d like to order a few tests to be sure there’s no problem . . . But I believe they’ll be normal.”
- “Your problem is due to stress
- Tips for Making the Most of Your Doctor Visit
Once patients understand the genesis of FGIDs and the role of both the mind and the body, they should be better equipped to effectively communicate with their doctor and develop an effective relationship with better health outcomes.
- Know the Four Major Functions of the Interview
- Information gathering
- Begin a therapeutic relationship
- Implement treatment
- Be clear on your agenda (what you need to do to get what you expect)
- Review and characterize your main complaint (s). This should include the location, quality (how it is affecting you): factors making it better or worse; time of onset and frequency/duration; why are you here now (if chronic); what are your worries and concerns.
- Describe its impact on your quality of life (work, social, emotional, sexual, role) and its effect on your family.
- Describe what you think you have
- Raise any concerns and fears
- If needed, ask to bring a family member or friend
- Embrace Guidelines for Patient Centered Care
- Have realistic goals and objectives for the visit; the clinical outcome (with chronic illness there is no “quick fix”); and for your role in self-care.
- Your health care provider is a partner and advisor and the best outcome is when the patient shares in the clinical decision making. That is why it is vital that when communicating with your provider you:
- Listen actively
- Seek clarification if you don’t understand
- Take responsibility to address your issues and concerns
- Ask questions
The following video provides information as to why patients with disorders of gut brain interaction may be misunderstood and maltreated because of the lack of understanding of their true basis for their symptoms, especially when the doctor or patent keeps searching for another disease.
Watch this video for a summary of the above skills
For further information on educational programs to teach patient centered care visit www.drossmancare.com
For information about Dr. Drossman’s patient practice visit www.drossmangastroenterology.com