Clinicians who want to improve treatment for IBS and IBD have a simple charge: Improve their patient communication skills.
“It is not so much what you do as how you do it that affects outcomes,” said Douglas Drossman, MD, AGAF, private practice gastroenterologist and professor emeritus at the University of North Carolina, Chapel Hill. “It is not how effective your treatments are; it is how satisfied patients are with your care.”
Patients with functional IBS, IBD and other disorders want four things from their clinician, he continued, during Saturday’s AGA Postgraduate Course Luncheon Breakout Session Maximizing the Patient-Provider Relationship Using Effective Communication Skills for IBD and/or IBS.
They want some level of technical competence. They want the provider to be integrated into their psychosocial world. They want humane behavior. And they want biomedical information, but not so much they can’t comprehend it.
“If patients are satisfied with their physician, the physician is usually satisfied with the patient,” Dr. Drossman said. “And we know that physicians who are not satisfied with their patients are at higher risk for burnout and for malpractice suits. Malpractice is less about what you did than how you communicated with the patient.”
Improving patient communication begins with active listening. Rather than questioning the patient in detail, listen to what they say and how they say it.
“We can work too hard asking questions,” Dr. Drossman cautioned. “If you sit back and listen, you can learn a lot more. Then you can go back with more targeted questions.”
The next step is to identify the patient’s agenda. Patients schedule visits because of symptoms, but there are always deeper concerns they may be reluctant to bring up. It is important to acknowledge and validate patients’ feelings about their symptoms and their disease, Dr. Drossman added. It is easy to view functional illness as being less “real” than an organic defect.
“You can’t rely only on endoscopic data,” he said. “You have to acknowledge that their pain is real.”
Understanding and addressing the patient’s concerns is key, said health psychologist Laurie Keefer, PhD, AGAF, associate professor of gastroenterology and psychiatry at the Icahn School of Medicine at Mount Sinai, New York, NY. Patients need help adjusting to the chronicity of their disease and the roller coaster of flare, remission and flare.
They must deal with social stigma and potential financial implications.
Treatment adherence also can be an issue, particularly during periods of remission. Patients may be afraid of the drug delivery system, whether it is injection, infusion or even pill swallowing. Patients with severe or long-term disease can be appropriately concerned about being accommodated as needed or becoming disabled.
And most patients have extra-intestinal and treatment-related concerns around body image and weight gain from steroids. There also may be worries about ostomy, fatigue, disability and a variety of other issues.
“There is a lot of anxiety that goes along with these conditions,” Dr. Keefer said. “Knowing that the provider is on that journey with you can make a big difference in how well patients manage their disease.”