How Doctors Think about IBS
Introduction
I had a friend who helped me startup a counseling center.
He was a neurologist, who said something that really stayed with me. He said “When I see a patient for the first time, I know within five minutes what I’ll find on examination, and how I’ll treat the person. The rest is interaction–teaching and listening.”
How can he know within five minutes what is going on with a patient? Here is a quote from a medical review article on IBS that lays it out. Knowing this information, and related information about other disorders and diseases, a doctor — all right, a good doctor — is generally quite clear on what to do next. It’s just that the patient, one of us, is still in the dark.
The Bullet
The doctor is practiced in knowing and reciting back “the bullet” - the briefest possible summary of a disorder or disease, and the briefest possible summary of a patient, his or her complaints and treatment. Here in the opening paragraph of a review article on Irritable Bowel Syndrome, is “the bullet.”
New England Journal of Medicine Article
Irritable bowel syndrome, a common disorder in which bowel habits are altered in association with abdominal pain or dis comfort, has a prevalence of 12 percent among adults in the United States and a similar prevalenceworldwide. By definition, no mechanical, biochemical, or overt inflammatory condition explains the symptoms. Validated, symptom-based criteria for the diagnosis of irritable bowel syndrome are highly predictive in the absence of alarming symptoms such as weight loss, fever, and intestinal bleeding. The pain or discomfort experienced by patients with irritable bowel syndrome often leads to health care use and a decreased quality of life. Diarrhea is a symptom that often leads to medical consultation, since it can be inconvenient and, if associated with urgency, may be accompanied by fecal incontinence, an altered lifestyle (owing to frequent trips to the bathroom), and anxiety. Constipation may be associated with bloating, discomfort, and an altered body image. The quality of life was reported as impaired in people with irritable bowel syndrome who sought medical care but only marginally reduced in those who did not seek medical care. The therapeutic goal is both a reduction in the severity and frequency of symptoms and an overall improvement in the quality of life.1
How Disappointing
After you’ve gone through various tests beyond a simple blood test, all the way to having a colonoscopy, to be offered a “therapeutic goal” rather than a “cure” is a disappointment. So you may begin to distrust the doctor.
Now
What do you think?
- 1 Howard R. Mertz, M.D. “Review Article: Irritable Bowel Syndrome,” New England Journal of Medicine, 349:22, November 2003. [↩]