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A specialist in irritable bowel disorder and other "functional" GI conditions offers advice on dealing with patients whose symptoms aren't easy to categorize. His pointers would apply as well to patients with chronic musculoskeletal pain and enigmatic rheumatologic disorders.
If a patient has symptoms that stubbornly refuse to fit into any easily identified category, physician and patient will be less frustrated if both accept the status "functional disorder" and move on from there. This advice comes from a gastroenterologist who has specialized in irritable bowel disorder and similar syndromes, but his advice on doctor-patient communication can equally well serve physicians who must treat chronic musculoskeletal disorders.
In a recent study, residents felt that patients with "organic diseases" had more disability than those with "functional disorders," even when the presenting symptoms were identical, says a report in ConsultantLive about Dr. Drossman's presentation. He advised clinicians to leave such biases and negative judgments outside the examining room.
Douglas A. Drossman, MD, was speaking at the American College of Gastroenterology 77th Annual Scientific Meeting in Las Vegas. He is President of the Drossman Center for Education and Practice of Integrated Care and Professor of Medicine and Psychiatry, UNC Center for Functional GI and Motility Disorders, Chapel Hill, North Carolina.
His pointers on constructive communication with patients whose symptoms are persistent but difficult to explain or resolve:
1. Identify agendas. Be sure to ask your patient questions like, “What brought you here today?” “What do you think you have?” “What are you concerned about?” “What do you think I can do to help?”
2. Empathize. Recognize patients’ hardships as they cope with their illness and symptoms by saying things like, “I can see how difficult it is for you to deal with the pain.”
3. Validate feelings. Many patients with chronic disease bring concerns about their illness to the office, especially when an organic cause is not evident. Addressing their feelings by commenting “I can see you are frustrated” is important. Psychosocial components of the disease should still be addressed. Remind patients that although you believe that their symptoms are real and physical, things like stress, emotion, diet, and exercise can influence the symptoms. Tell patients that you would like to help them figure it all out.
4. Set realistic goals. Remind patients, especially those with chronic illness, that change may not come fast and may not be easy. Try to avoid responding personally to patients who challenge, “So what can you do?”
5. Educate patients. Determine what your patients know and what they think, and then address any misconceptions or misunderstandings about their symptoms, illness, and prognosis.
6. Reassure. This means reassure them that you have heard their concerns. Avoid false reassurances, like “It’s all going to be OK” or “There’s nothing to worry about.”
7. Use negotiation. Remember to leverage the physician-patient partnership and have the patient take responsibility. For instance, rather than ask “How is your pain?” ask “How are you managing your pain?” Also, present patients with options and involve them in making treatment decisions. Share choices, including risks and benefits, in language they can appreciate. Then ask them which direction they would like to try first.