Desale Yacob, MD, Pediatric Gastroenterology, Nationwide Children’s Hospital, Columbus Ohio, shares his experience after spending a week at the Drossman Center for the Education and Practice of Biopsychosocial Care. This guest blog post is his first-hand account of the experience, and appears unedited.
As the winter season continued to wreak havoc in the Midwest and elsewhere in the middle of March, I decided to head to Chapel Hill, NC and spend a week at the Drossman Center for the Education and Practice of Biopsychosocial Care. This is a center founded and run by Dr. Doug Drossman, one of the thought leaders in the study of functional GI disorders and founder of the Rome Foundation. His lifetime dedication in promoting the importance of patient-doctor relationship and patient centered care along with his work in the area of functional GI disorders has won him great admiration all over the world and inspired a new generation of doctors to practice medicine as medicine should be practiced.
As a pediatric gastroenterologist, I have come to appreciate the complexity of functional gastrointestinal disorders and the importance of having “a continuous healing relationship” with patients afflicted by these chronic illnesses. They happen to be very prevalent and chronic in nature with a significant impact on the patient’s quality of life and the health care system. These disorders unlike many other diseases are not diagnosed with a laboratory test or an imaging study. Establishing a diagnosis of irritable bowel syndrome, functional dyspepsia or any of the remaining functional GI disorders depends on a good patient doctor relationship and it demands that the patient’s story be told and heard, appropriate questions asked and that the disorders be understood and respected. Just as it is important to do so in establishing the diagnosis, it is just as important to do the same when embarking taking the patient on a therapeutic journey towards healing. All these are embodied in the biopsychosocial model which when practiced masterfully as it is at the Drossman Care center, spares patients from excessive testing, prevents delay in diagnosis, avoids unnecessary interventions and ultimately results in healing with dignity.
The objectives of my visit to the Drossman Center were to learn from the communication techniques and patient interview approaches that Dr. Drossman utilizes to establish a genuine patient doctor relationship, to understand and learn about his use of medications that target both the central and enteric nervous systems in the treatment of functional disorders and also to explore possible research projects in the field of patient-doctor relationship.
The first objective was met as I sat and observed Dr. Drossman interact with his new and follow-up patients who came from far and near. The center operates very efficiently and the patient’s visit starts long before he or she sets foot in the clinic. The team makes sure all the necessary paperwork and medical records of previous evaluation have been received and reviewed. When it is time for the patient to come to the room, Dr. Drossman’s physician assistant Kellie Bunn or his other assistant Nadia Hoekstra would join him and take notes as he converses with and interviews his patients. The presence of the other team members in the room serves multiple purposes.
First of all, it means the patient has Dr. Drossman’s undivided attention without any distraction but it also facilitates the follow-up care since they have met everyone on the team. His interviewing technique is to empower the patient and conduct the interview at the individual’s pace. He stirs the conversation very skillfully based on the information that he extracts and probes deeper as the person feels more and more comfortable to tell his or her story. Once he has completed the history and conducted his physical exam, he discusses the diagnosis and explains it thoroughly using visual aids making sure it is fully understood by the patient. He also leaves adequate time for follow up questions and further clarifications. Observing an entire patient session at the Drossman Center is like being in a studio watching an artist work on a masterpiece with all the shared qualities of patience, deep understanding of the subject at hand and passion for one’s profession.
My second objective was to learn about the medications Dr. Drossman uses in treating patients with functional GI disorders. His deep understanding of these disorders translates to an effective therapeutic approach that combines multiple elements. I was most impressed by his knowledge and judicious use of psychotropic drugs in patients who present with moderate to severe IBS and other pain predominant FGID. The word augmentation was mentioned frequently in our discussion of therapy for these disorders. Augmentation therapy with combinations of low dose psychotropic medications, or combinations of these drugs and psychological interventions yields better outcome and minimizes possible adverse reactions. This is an approach that is underutilized and one that can make a significant impact in the lives of many. It is clear that Dr. Drossman’s has been working tirelessly to educate medical providers.
When over a decade ago in 2001, the Institute of Medicine committee on quality of health care in America published its report under the title of “Crossing the Quality Chasm: A New Health System for the 21st Century,” one important directive to improve health care delivery was to provide patient-centered care. Five of the ten general principles that the committee identified to help redesign the health system relate to patient-physician relationship and they are:
1. Care is based on continuous healing relationships
2. Care is customized according to patient needs and values
3. The patient is the source of control
4. Knowledge is shared and information flows freely
5. The patient’s needs are anticipated. Developing a practical research project in the field of patient doctor relationship will be of paramount importance because it will inform health care providers on current practices and guide our future approaches.
The above principles listed by the Institute of Medicine committee are truly the pillars of the Drossman Center. The Center serves as proof that when these principles are practiced, the result is the type of health care that we all aspire to deliver. Despite the wintry temperatures, my week-long experience at the Drossman Center was very warm, inspiring and educational. I learned a lot from the vast experience of Dr. Drossman and his team. I also learned a lot from the many patients who were very gracious and kind to let me sit in and share their stories.
Desale Yacob, MD