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Gastroenterology

Doctor-Patient Communication, Part 1:

Observations on Ineffective Approach By Douglas Drossman, M.D.

In this two-part series, we evaluate two ap-

Doctor: (Frustrated) “OK, OK, I want to do

proaches to physician-patient communication.

a physical examination and then maybe we can talk about the plans, OK?” (Patient

Situation

looks dissatisfied.)

Ms. Simpson is a 38-year-old woman with several years of abdominal pain and bowel

After the physical exam

difficulties. Blood studies, barium enema

Doctor: “Well everything seems OK. I’d

and computed tomography have been neg-

like to do a blood test for celiac disease

ative. She has been on numerous medica-

and then a colonoscopy. (Patient looks

tions, including antispasmodics, fiber, pro-

surprised) No, it’ll probably be OK, this

biotics and antibiotics without benefit. She

way we’ll be sure there is really nothing to

is depressed and frustrated and asks her

worry about. So don’t worry.”

doctor for a second opinion.

Patient: “Doctor, what is it that I have? I’ve been reading online about patients that

Dr. Douglas Drossman graduated from Albert Einstein College of Medicine and was a medical resident and gastroenterology fellow at the University of North Carolina. He was trained in psychosomatic (biopsychosocial) medicine at the University of Rochester and recently retired after 35 years as professor of medicine and psychiatry at UNC, where he currently holds an adjunct appointment. Dr. Drossman is president of the Rome Foundation (www.theromefoundation.org) and of the Drossman Center for the Education and Practice of Biopsychosocial Care (www. drossmancenter.com). His areas of research and teaching involve the functional GI disorders, psychosocial aspects of GI illness and enhancing communication skills to improve the patient-provider relationship.

New physician interview

have the same symptoms that I do and they

Doctor: “How can I help you?”

call it IBS (irritable bowel syndrome). Is

Patient: “Well, when I came back from

that what I have?”

vacation, I got a flare up of whatever it is I

Doctor: “Perhaps, but we first need to rule

have… nausea, diarrhea, fatigue and stom-

out anything organic.”

ach pain. (Pause) So Dr. Jones thought I

Patient: “What’s ‘organic’?”

should see you and… .”

Doctor: “I mean something specific that

Doctor: (Interrupting) “Was this like some-

we can treat. If the studies are negative, I’ll

thing you’ve had before?”

put you on an antidepressant to feel more

Patient: “Well, yes, but it’s never been this bad.”

comfortable with your symptoms.”

Doctor: “Is it made worse by food?”

Patient: (Looking confused) “Doctor, I’m

Patient: “No. Do you think it’s something I ate?”

not depressed… . I just can’t deal with the

Doctor: “I don’t know yet. Did you have

pain. I… .”

diarrhea or fever?”

Doctor: (Interrupting, turns back to patient)

After the physical exam, the education and

Patient: “I think so… but I didn’t take my

“No, I’ m sorry; I didn’t say you were

treatment plan was ineffective. He recom-

temperature.”

depressed. These medications can help

mended tests without summarizing his ob-

Doctor: “So you have diarrhea and fever?”

your symptoms. Look, let’s just see what

servations, making a diagnosis or offering

Patient: “Uh no, I get constipation too,

the tests show and then we can take it from

education. His reassurance was ineffective;

but that’s normally when I’m not eating

there, OK?” (Patient looks disappointed.)

this ended the discussion and left the pa-

Drossman Gastroenterology P.L.L.C. (www. drossmancenter.com) specializes in patients with difficult-to-diagnose gastrointestinal disorders and in the management GI disorders, in particular severe functional GI disorders. The office is located at Chapel Hill Doctors, 55 Vilcom Center Drive, Suite 110 in Chapel Hill. Appointments can be made by calling (919) 929-7990.

tient disappointed.

well. I know some diets can help, and it’s important to eat regular meals, right? I do

Observations

know that if I eat fatty foods I get pain and

There are several observations about this dia-

The physician delegitimized IBS by seeking to

I feel queasy right here. (Patient starts to

logue that demonstrate ineffective communi-

identify “organic” conditions, which he pre-

look concerned). Doctor, I’m really worried

cation skills. The interview was non-facilita-

sumed to be treatable. The recommendation

about this. ”

tive and did not disclose helpful information.

to take an antidepressant was rejected by the patient, who assumed it was given for depres-

Doctor: (Ignores affect) “I’m sorry I’m not

sion, which she did not believe she had.

quite following. What type of bowel prob-

The doctor did not actively listen and spoke

lems did you say you are having? ”

from his agenda rather than the patient’s. He

Patient: (Folds arms) “Normally I get

asked closed-ended questions and frequent-

In part two of this series, we will discuss a

constipation, but when it’s really bad I have

ly interrupted. He seemed frustrated when

more effective approach to this physician-

diarrhea too.”

not understanding.

patient encounter.

december 2014/January 2015

13

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