In Collaboration With The

What Doctors Are Saying About Gut Feelings

"I’ve been waiting for this book for quite some time. I knew there were more diagnoses than IBS and Non-Ulcer Dyspepsia in what I used to call functional GI disorders. But I was never sure what they were or how to deal with them. This easy-to-read book provides the answer. There are now 33 adult and 20 pediatric disorders where there is some derangement in the brain-gut neuroaxis.

The authors call these Disorders of Gut-Brain Interaction (DGBI) to capture multiple physiological and psychosocial abnormalities. This leads to the fundamental point that medicine must embrace a biopsychosocial model. That is, integrate the well-described physiological changes with the lucid presentations of the psychological and social issues these patients exhibit, culminating in a caring, respectful patient-doctor relationship.

The credibility of the authors is impeccable. Dr. Drossman’s entire career, often mediated via his efforts through the Rome Foundation, has been devoted to providing the research and conceptual basis for a remarkable evolution in U.S. medicine: DGBI are the most completely described biopsychosocial disorders. This not only helps patients and practitioners but also guides the remainder of medicine in this new direction. Just as compelling is Ms. Ruddy’s personal story as a patient with IBS and how she suffered profoundly until treated by someone who understood the biopsychosocial model. You’ll have to read the book to find who that was.

Added benefits for the reader are the multiple taped interviews presented throughout the book, including one rarely seen of Dr. George Engel who described the biopsychosocial model—and to whom the book is dedicated. Further, in Part III, the authors capture the basis of treatment of all DGBI by detailing how best to communicate and establish a powerful patient-physician relationship. Read this book to be current on modern thinking about how our patient’s biological, psychological, and social features interact in ways that dictate unique treatments for each. "

Robert C. Smith, MD, MACP
University Distinguished Professor
Professor of Medicine and Psychiatry
Michigan State University, College of Human Medicine
East Lansing, MI 48824-7016
"You know a “must-read” book when you see one, and Gut Feelings - Disorders of Gut-Brain Interaction (DGBI) and the Patient-Doctor Relationship [PDR]: A Guide for Patients and Doctors certainly is in this class. During my twenty-plus years of providing clinical care as an internist and gastroenterologist, how many times did I consult a different PDR (Physicians’ Desk Reference) and reach for a prescription pad instead of spending more time talking with my patients to thoroughly understand their health needs and goals? How many times did I initiate a “vicious cycle” of repeating lab or imaging tests and endoscopies that, in the end, were not productive? Instead, I could have embarked on a “virtuous cycle” of collaborative, illuminating discussions and practiced shared decision-making with my patient partners. As patient-centered as I wanted to believe I was, I reached a stark conclusion after reading Gut Feelings: I wished this book had been a part of my training curricula during medical school, residency, and fellowship because I would have done better in my time as a physician provider.

Gut Feelings is an essential resource for all participants in the health care system–not just patients and doctors– because we are or will be patients. The core of care delivery is the patient and their provider, and this guide focuses on how to successfully activate optimal patient-physician engagement. The clinical topic area is non-structurally based maladies of the gastrointestinal tract known as DGBIs. But this book will be helpful to all patients and all care providers dealing with any disease process, be it of structural or non-structural cause. Further, all other health care system stakeholders will gain insights into what “great” can look like in an invigorated patient-provider relationship (PPR).

Gut Feelings is a prescription for success for the PDR because its two authors are unique and cooperative individuals. One is a credentialed educator, a professional advocate of patients and communities through her work in non-profit organizations, and a patient herself who, with heart and soul, courageously and effectively shares her personal illness experience. The other is a dedicated doctor and innovator who, among his many other medical scientific academic achievements, has led the charge for decades in “writing the book” on DGBIs, better known as the Rome Criteria, a system of disease classification that enables diagnosis and treatment of affected patients. The collaboration by these two authors, and as patient and doctor, models the finest of PDR functioning; for these reasons and the excellent content in this guide, I urge all readers to heed and follow the advice provided in this book and to support its use and related materials in all clinical training programs for the benefit of patients and providers alike. "

Douglas S. Levine, MD, AGAF, FACG
Manager and Sole Member, DSL Consulting LLC
Consultant to the Executive Committee, Rome Foundation Research Institute
It is an honor and pleasure to recommend Gut Feelings for both physicians and patients. Written by Douglas A. Drossman, MD, one the world’s leading physician-educators and investigators of Disorders of Brain-Gut Interactions (DBGI), formerly called FGID, and by Johannah Ruddy, M.Ed., a patient, and an accomplished patient advocate, this book concentrates on developing skills in diagnosis and treatment. It teaches how to improve physician (caregiver)-patient communication and how to create a trusting physician-patient relationship, it develops the critically-important concept of defining and treating illness rather than disease, it summarizes the definitions, pathophysiology, diagnosis, and treatment of DBGI based on guidance of the Rome Foundation (an organization of physicians and lay people whose mission is to educate care givers and patients on communication and on diagnosis and treatment of DBGI), and creates a guide for caregivers using a practical approach to diagnosis and treatment using Rome criteria and processes. Therefore, my recommendations:  

If you are a physician, mid-level provider, or nurse and you want to communicate better with your patients to develop a rapport-based relationship- read this book. While the thrust of this book is toward gastrointestinal diseases, caregivers in other medical specialties can benefit greatly from the practical wisdom in this publication because there are so-called ”functional disorders” in every specialty of medicine.
If you are a gastroenterologist and you realize that 20-40% of your patients have DBGI, and you need tools to better diagnose and manage these patients- read this book.

If you are already an advocate of the Rome Foundation approach to functional illnesses but would like supplemental educational material to enhance your ability to use Rome IV concepts- read this book.
If you are a patient and have been told by your physician that you suffer from a “functional” illness (such as irritable bowel syndrome) and you wish for a better understanding of your caregiver’s approach to your illness and how you might partner with them improve the outcome of treatment- read this book.

Douglas Drossman is a master at conveying the concept that patients come to their physician with an illness, not a disease, and that the most fruitful way to reach a diagnosis and develop useful treatment comes from considering these illnesses as an interaction between the mind and body. This means that to be a good caregiver, you must be able to understand, as best you are able, what in the patient’s mind that is driving the body’s symptom response. This understanding demands interviewing skills and the ability to engender trust between the patient and caregiver. Doug Drossman teaches these skills better than any physician-educator I have ever observed. Indeed, I benefitted greatly from his teaching in our younger days at the University of North Carolina at Chapel Hill where we practiced together first as teacher/student and then as faculty colleagues. 

Johannah Ruddy brings the critical view of a patient and the experience of a patient-advocate to validate the concept of the value of the physician-patient relationship. The patient’s viewpoint is usually missing from a conceptualization of the physician’s most important function: how they interact with the people they treat. Johannah’s views temper the knowledge in this book and give the narrative a real life meaning. 

Through biomedical research, the physician-scientist (I am one of those) strives to understand the fundamental physiological derangements that cause symptoms and disease, hoping to discover the silver bullet that will treat the disease and alleviate patient suffering. However, to date, there is still no clear biomarkers to define DBGI, and furthermore, no magic bullet to cure them. Emerging concepts of the gut microbiota, in my view, offer the best hope for this more conventional scientific approach because it has been shown that changes in the gut microbiota can affect the brain (behavior) as well as gut function. But definitive discoveries and therapies are still a long way off. In the meanwhile, patient communication, developing a strong physician-patient relationship and use of the Rome IV criteria for diagnosis while employing their recommended approach to judicious testing and treatment are proven means for caregivers to deliver effective patient-centered medical care.

Don W. Powell, MD
Professor Emeritus, Internal Medicine/Gastroenterology
University of Texas Medical Branch at Galveston 
If you are a person suffering with irritable bowel syndrome or a number of other “functional GI disorders,” or if you are a physician who treats these conditions, this is the book for you. In this marvelous resource Dr. Drossman, one of the world experts in disorders of gut-brain interaction (DGBI), and Founder and President Emeritus of the Rome Foundation that has re-defined and classified these disorders, distills a lifetime of research and practice to shed new light on the understanding, diagnosis and management of these illnesses.

Drossman explains how, through the lens of the biopsychosocial model, the false dichotomy of organic versus functional becomes irrelevant. Humans are incredibly complex beings intertwined with their environments, families, friends, and societies. Disturbances in any of the spheres in which we live affects us down to our individual organs and cells. Adverse childhood experiences can change our brains and our physiologic responses to stressors as adults. Our genetics can affect our ability to be resilient or the dynamics of brain-gut regulation. E coli infections can change our microbiomes, and set us up for alterations in GI motility, pain sensitivity, and immune function. Physicians who tell their patients that “nothing is wrong,” and “work on reducing your stress” are contributing to their sense of stigma and isolation. But a physician who truly understands these disorders, explains them clearly, and empathizes and works with their patients over time empowers them to take steps that lead to symptom control and healing. Dr. Drossman offers detailed explanations and concrete suggestions to achieve these outcomes.

Co-author Johanna Ruddy offers is a riveting narrative of her illness experiences that reveals an inner world of pain and suffering that physicians don’t often explore or perhaps even want to understand. Yet they must understand to come to empathy and compassion for patients with these disorders. The lessons of this book, while focusing on DGBIs, have relevance for all healthcare interactions, and will help physicians and patients alike understand, cope and heal. I am a practicing physician of almost 50 years and have often treated patients with these disorders; yet I still found this book enlightening and useful. If every physician read, digested and embraced the suggestions in this book, I believe healthcare would improve immensely.

Dennis H. Novack, M.D.
Professor of Medicine
Associate Dean of Medical Education
Drexel University College of Medicine
Philadelphia, PA
As a primary care physician, I have struggled to help hundreds of patients with irritable bowel (IBS). IBS and related disorders can be frustrating for both patient and doctor, intractable, and life diminishing. They are hard to explain. So, when my lifelong colleague and friend Doug Drossman sent me a draft of Gut Feelings, I was deeply delighted. Above all it is clear. But it is also comprehensive, sophisticated, and practical. I will give it to all my IBS patients and sit with them to discuss its profound insights! Get it, read it, share it.

Mack Lipkin MD
Professor of Medicine
Primary Care
NYU School of Medicine
Dr. Drossman and Johannah Ruddy’s collaboration is a much-needed addition to the field of medicine, particularly in regards to the evaluation and management of chronic illness. While the healthcare system has failed doctors and patients alike, this book provides insight into why Disorders of Gut-Brian Interaction (DGBIs) have been misunderstood and poorly treated in the field of Gastroenterology. This book, in addition to the resources provided by the Rome Foundation, works to bridge the gap between doctors and patients through improved communication and confidence that a diagnosis can be made and proper care will be provided.

Working as Dr. Drossman’s PA in his private practice, I witnessed the implementation of the patient-doctor relationship guidelines in this book. Providing clear messages to the patient and working with the patient to help them take an active role in their care plan, really working together as a team, lead to drastic improvements in quality of life for the majority of our patients. This book is a great starting point for any medical providers that want to learn more about how to improve their relationships with patients and avoid burnout.

Meghan Huff PA-C
Professor Douglas Drossman has always quickly and correctly identified the main needs in medical practice and education. When the functional gastrointestinal disorders were ignored, he set up a complex working group which succeeded to establish the standards in the field. When he observed that the medical-patient interaction needs improvement, he started to a long series of lectures, videos and publications to educate the healthcare providers. He also felt the need to educate the patients and created training programs for them, in collaboration with patients’ associations.

Now he is back on stage with the book Gut Feelings written together with Johannah Rudy. The book benefits of the introduction of two eminent specialists in the field: Ling Chang and Jan Tack, and both their forwards give from the beginning the guarantee of the high quality of this book. 
Indeed, the book is more comprehensive than the title would suggest. It is a monograph on the disorders of gut-brain interaction. The structure of the volume is as follows: 

Part 1 is dedicated to conceptual and scientific background of the gut-brain normal and disordered interaction. Part 2 described the clinical entities in a very clear style, accessible to healthcare professionals and patients as well. The 3rd part is the outcome of long years interest on to improve the relationship between medical staff and physicians. The psychosomatic background of the author has contributed to this empathic approach. This part is very useful mainly to medical trainees. The last part contains practical advice for medical doctors when managing functional patients.

The complete Rome IV diagnostic criteria are reproduced in the appendix, and is a useful resource information for patients and referring doctors.

In conclusion, this is a fantastic book that will represent again an unavoidable reference for practitioners and patients. A book on gut feelings dedicated to our mind feelings!

Dan Dumitrascu MD, PhD
Professor, Iuliu Hatieganu University of Medicine and Pharmacy
Cluj-Napoca, Romania

Gut Feelings” is an extraordinary resource on understanding and communicating complex pathophysiology of Gut-Brain interaction disorders. The book is a culmination of Doug Drossman’s lifetime of experience learning from and helping patients with Disorders of Gut-Brain Interaction. The biopsychosocial framework developed by George Engel really saw its pivot for functional gut disorders by Doug’s work over his career. This model continues to provide most ideal conceptual integration for bidirectional interaction between regulation by the central nervous system and peripheral factors such as inflammation and microbiome. Recent advancements in the field have provided robust scientific evidence for these interactions that are masterfully covered in this book.

The book is also clear on the importance of communication skills and the patient-doctor relationship. In this fact-paced world, a dying art is how to demonstrate empathy, validate and help our patients understand these disorders. This book provides real life strategies that can be instrumental in achieving those goals leading to strengthening of the bond between the doctor and their patient.
 I believe this book will serve as a great tool for clinicians and patients as it simplifies dense concepts around our understanding of Gut-Brain interaction disorders while providing cutting edge and up-to-date scientific data.

Madhu Grover MBBS
Assistant Professor
Gastroenterology and Hepatology
Mayo Clinic, Rochester MN
The book Gut Feelings: Disorders of Gut-Brain (DGBI) Interaction and the Patient-Doctor Relationship. A Guide for Patients and Doctors is unique in many respects and its singular value stems from this uniqueness.

First it is jointly written by a doctor, Dr. Douglas Drossman and a patient, Johannah Ruddy, each presenting their perspective on their own personal doctor-patient relationship. Dr. Drossman brings to this engagement (and the book) his background as the pioneer in the categorization and legitimatization of the DGBI, his role as a leader in the application of the biopsychosocial model in the DGBI, and his guidance in the implementation of communications skills in the treatment of patients with DGBI and the training of generations of young doctors.

Particularly for Ms. Ruddy, we learn about her frustrations and dissatisfaction with standard care and the positive dynamic that developed when she met a doctor who put her at the center of their relationship in a patient-centered care approach. The result from her point of view was life-changing and for Dr. Drossman this led to professional satisfaction with the course of treatment and its outcome. Eventually, it led to special collaboration between them, hopefully to the benefit of many other patients and doctors.

Second, it is written for doctors, patients, and the general public. This is difficult because the authors have to avoid using medical jargon that doctors understand, but patients do not, and to avoid too much simplification that could be perceived as patronizing by patients and too basic by doctors. The authors have overcome this obstacle admirably.

Third, the case discussions, especially Ms. Ruddy’s detailed presentation bring the text to life and provide a living basis for the rest of the book.

Finally, the ample use of cartoons and videos contributes significantly to the effectiveness of the book.

Many doctors perceive patients with DGBI as “difficult” or “problematic.” This book can help doctors see them as “interesting” or “challenging” and as a source of professional and personal satisfaction by adopting the patient-centered care approach and systematically improving the communication skills that are at its core. It can improve the “patient experience” for many by learning from Dr. Drossman and Ms. Ruddy’s story through his highly toned skills as a communicator and healer and Ms. Ruddy’s advanced patient advocacy skills.

Ami D, Sperber, MD, MSPH
Professor Emeritus of Medicine
Faculty of Health Sciences
Ben-Gurion University of the Negev
Beer-Sheva, Israel
As patients travel through the healthcare ecosystem to reach the destination of better health, they need a roadmap and preferably an experienced guide who knows the ropes. It is demanded that this pathfinder be able to talk with them effectively in common words, concepts and understand the culture. This book: Gut Feelings by Drossman and Ruddy accomplishes this. 
Disorders of gut-brain interaction (DGBI) are becoming highly recognized in the scientific community, but there is a lack of consistent systematic knowledge among clinical practitioners about their presentations, etiologies and the application of person-based management for the health seeking patients. Consequently, patients have not been able to find an efficient, reliable source of information. Instead, patients face disinformation, misinformation and regularly malformation, all of which may cause their disorders to worsen or even precipitate and make management more complex. Interestingly, the authors organized the variety of topics in the contents to overcome this problem. They clarified technical terms and provided easy to understand information relating to diagnosis and the management pathways that were formed by the Rome Criteria and MDCP. They integrated these tools with their clinical knowledge to produce this product. This was a hard task, but well done.
"Gut Feelings" is suitable for patients who intend to increase their understanding to overcome the malady and take a more participatory role in self-management, and even can be used as textbook or syllabus of training programs for patients and primary care providers. Due to increasing burden of DGBI, epidemiologically as well as abnormal emerging healthcare seeking, both aspects of application of this book (self-education and didactic) are very welcome.
Peyman Adibi, MD
Professor of Medicine
Affiliated professor of medical education
Isfahan University of Medical Sciences
Isfahan
Iran
Although long-retired, I have worked and corresponded with Dr. Drossman for over 40 years. We share a concern for the lack of understanding of the Disorders of Gut-Brain Interaction (DGBIs). Lacking a structural explanation, many factors stand in the way of the study, diagnosis, and treatment of these common syndromes.

Dr. Drossman has become a widely recognized expert in these disorders, and an advocate of doctor-patient collaboration in dealing with them. Through his research and careful interactions with patients he has developed a comprehensive approach featuring the use of diagnostic criteria, interactive interview skills, and collaborative treatment plans.

Notably, in Gut Feelings Dr. Drossman collaborates with a patient to illustrate the intricacies of the management of DGBIs. Ms. Johannah Ruddy, who I have not met, seems a highly intelligent and educated patient, and educator, who with Dr. Drossman’s help has successfully struggled to understand and manage her own symptoms. Their book will be of benefit to those frustrated by their DGBI symptoms, and to doctors who strive to care for them.

W. Grant Thompson MD, FRCPC
Emeritus Professor of Medicine,
Former Board of Directors, Rome Foundation
Ottawa, Ontario, Canada
I had the privilege of reviewing "Gut Feelings: Disorders of Gut-Brain Interaction and the Patient-Doctor Relationship in September 2020.
 
This is an outstanding resource by the doctor who pioneered and continues to practice, teach and research 40 years later, the identification, effective management and most recently the re-naming of "functional disorders", during a time that these disorders were unpopular with gastroenterologists and primary care doctors who thought them to be primarily psychological. 
 
Dr. Drossman is personally responsible for the creation of the Rome Foundation, which has defined these disorders and the patients who experience these disorders, and he has validated rapidly growing interest in the research of the underlying pathophysiology and treatment of these disorders.
 
He is joined by his colleague, Ms. Ruddy, who provides a very personal and pertinent perspective related to her own journey.

The manuscript is packed with links to videos, both amusing and educational, and also cartoons that most doctors and many patients will find amusing, albeit sometimes a little too close to the truth.
 
Part 1 is a fascinating background, written as an extension and expansion of Dr. Drossman's article entitled "Functional Gastrointestinal Disorders : History, Pathophysiology, Clinical Features, and Rome IV" in Gastroenterology 2016, but is actually a complementary description and is written in a more friendly and accessible style than the necessarily academic language of the Gastroenterology article.
 
Part 2 is a comprehensive and thorough review of every one of the Rome IV disorders. Each disorder is expanded with the author’s clinical wisdom, written in a very accessible and personal approach. His explanations, and his succinct summary of treatment recommendations, essentially makes each one of the 33 adult DGBI’s almost as valuable as an individualized clinical consult. This part of the book is more difficult to read in continuity, but serves as a reference for each individual disorder.
 
Part 3 is a very readable (and is at times sad, and frankly embarrassing to me as a doctor) expansion of the paper written by Dr. Drossman and Ms. Ruddy, published in the June 2020 issue of Clinical Gastroenterology and Hepatology. Dr. Drossman brings his astute observations of 40 years of clinical practice in the area and Ms. Ruddy brings her equally astute observations of a 25+ year journey involving abuse, pain, inadequate medical assessment and desperation. Fortunately, her journey was interrupted by her development of a therapeutic, and to a major degree a “healing”, doctor-patient relationship with Dr. Drossman himself. The authors may feel that “healing” is a wrong word. From reading this book, it is obvious that the goal of managing the DGBI’s is a partnership of management, a therapeutic relationship, and ultimately, improvement of quality of life. In my opinion, this book and the concepts within facilitate the “healing” of the distress associated with the DGBI’s, even when the symptoms continue.
 
Ms. Ruddy provides an academic insight into many issues that are common for patients with DGBI’s– many unfortunately related to issues of gender, but also issues of societal, racial and religious biases that impact on the care received and delivered in most Western countries.
 
Dr. Drossman then follows on with his expert insights into the key elements that optimize the patient-doctor relationship and provides detailed and specific advice about what a patient should be able to expect and how doctors could, and should, improve the patient experience. Use of these rather simple recommendations will actually dramatically improve the chances of improvement in the patient’s condition.
 
Part 4 sets out, in a simple and logical manner, what the patient needs to understand about how a good physician should go about assessing and treating the DGBI. In addition, Dr Drossman expands with 14 “tips” (which I would call “rules”) that will improve the communication between the doctor and the patient.
 
After spending several hours with this manuscript, I felt that I had experienced the luxury of a personal visit and a long and meandering conversation with Dr. Drossman and Ms. Ruddy. Despite 30 years of clinical practice, I felt significantly empowered and improved in managing and helping some of the very large number of patients who continue to suffer under the constraints of 21st Century medicine.
 
Eoin Lalor, MB ChB, Gastroenterologist
Ontario, Canada
This is the ultimate resource for patients with Disorders of Gut-Brain Interaction (DGBI), formerly known as FGIDs. Instead of looking for answers on the Internet from non-serious sources, it is written by a worldwide expert in the field, Dr. Douglas Drossman– from my point of view, probably the father of DGBI– and a patient’s advocate, Mrs. Johannah Ruddy. Ms. Ruddy’s story as a patient will certainly help others to understand their DGBI and become aware of what they must look for when searching for medical care.

The book starts with a classic, real-life clinical case of a patient with a DGBI, and explains the biopsychological underlying mechanisms of these disorders, their classification according to the target organ within the digestive tract each of the DGBI in adults, adolescents/children and neonates/toddlers. It also includes treatment recommendations and advice based on scientific evidence and the vast experience of Dr. Drossman. There are explanations for each disorder in a very down to earth language for patients, public and even physicians who are not specialized in these disorders. There are links to videos and other sources of information that complement the knowledge, herein provided. There are also great illustrations and cartoons that help to convey many of the concepts expressed in this book. And most importantly, a guide for patient-doctor relationship for both patients and doctors.

Max Schmulson, MD
Professor of Medicine
Facultad de Medicina
Universidad Nacional Autónoma de México (UNAM)
Laboratorio de Hígado, Páncreas y Motilidad (HIPAM)
Unidad de Investigación en Medicina Experimental
Hospital General de México
Mexico City, D.F., Mexico
Johanna Ruddy uses her own experience to educate doctors on how much DGBI patients need doctors to listen to their feelings, understand their pain, and help them. For doctors, learning effective communication skills and establishing good relationships with their patients is essential and the best shortcuts to improve the clinical outcomes of DGBI. Dr. Drossman and Ms. Ruddy, in their book, teach us comprehensive skills to build a good patient-doctor relationship. I think these skills are also extremely helpful for doctors and patients in different cultures and health care systems.

Xiucai Fang MD
Professor of Medicine
Department of Gastroenterology
Peking Union Medical College Hospital
Chinese Academy of Medical Sciences and Peking Union Medical College
Beijing, China
Reading this book, which feels like a timely gift as a fourth-year medical student nearing the end of my undergraduate medical education (UME), I am humbled and overwhelmingly affirmed in my choice to become a physician. Gut Feelings equips doctors-in-training like me with an arsenal of knowledge, wisdom, and practical skills that are immediately applicable for our patient care as well as our inner work and fills a major content gap that is presently missing from our mainstream academic medical education.

Operating within the practical constraints of system that values board scores and checklists, my formal instruction in learning the art of medicine has been found in a jam-packed 2-year preclinical course (where instructors are responsible for teaching the nuts and bolts everything from the HPI to the formulation of an assessment and plan) and an often chaotic and piecemeal clinical environment. This book has significantly augmented my sense of mastery in this domain by effectively tying together the best insights out there about how to genuinely optimize the therapeutic bond between doctor and patient. Dr. Drossman and Johannah Ruddy use their collective expertise to emphasize the power that a sustaining and mutual patient-doctor relationship (PDR) has for the healing of patients, including those with complex conditions that have been historically dismissed, as well as for physicians! For us (future) doctors, this book is an inspirational window in how any of us can push back against a status quo that perpetuates stigma and center humanity, humility, and curiosity in our work to prevent burnout and remain grounded in our mission to heal.

Notably absent from UME is any focus whatsoever on DGBIs (aside from a slide or two on IBS in GI Pathophysiology) and an explicit focus on “illness without disease.” If this book were required reading for all medical students, our generation of physicians—across the spectrum of specialties—would be better equipped to treat any and every patient, and validate within patients and ourselves the complex and inextricable links between mind and body. I see this re-integration, epitomized by the DGBIs, as the future of medical care and practice.

Indeed, Gut Feelings is a gift to caregivers and patients present and future. I am certain that I will return to this book throughout my training and practice, to connect and re-connect with Dr. Drossman and Johanna Ruddy’s stories. Undoubtedly, the wisdom found within the pages of Gut Feelings will help usher more compassionate, competent, and effective physicians and human beings!

Jordyn Feingold, MS4
Icahn School of Medicine at Mount Sinai
While intuitively obvious that the doctor-patient relationship is important to overall health, this book is actually one of the first of its kind to address best practices for building a healthy and therapeutic relationship between doctors and patients with chronic conditions. I cannot stress the importance of this perspective. Prior attempts to improve care have focused on only one side of the equation– how providers can increase patient’s motivation to follow their personal recommendations!  
 
Johanna Ruddy, M.Ed. brings to the table a critical perspective on how to move past some of the stigma, miscommunication, anxiety and anger that can happen to patients and families during a health crisis and instead focuses on finding a path forward that allows for healing through true patient-centered care. She exemplifies the importance of resilience and optimism in chronic disease management, demonstrating that 1) giving up is not an option; 2) one cannot simply “settle” for symptoms that interfere with you achieving your full potential; 3) it is possible to be heard and respected in a doctor-patient relationship. 
 
Doug Drossman, MD is someone that all physicians should emulate- one who considers patients in context- through the biopsychosocial model, a scientific framework in which the brain and the gut cannot be disentangled. In this book, Dr Drossman embodies and models true collaboration and shared decision making with a patient. 
 
While this book focuses on the complex disorders of gut-brain interaction, it can apply more broadly to the doctor-patient relationship in the management of any chronic condition.
 
Laurie Keefer, PhD
Professor of Medicine and Psychiatry
Icahn School of Medicine at Mount Sinai, New York, NY
Only recently has the powerful connection between our brain and our gut been recognized broadly by physicians and discussed in the mainstream among lay people and the media. It would make you believe that this science is new, yet Dr. Douglas Drossman has been on the cutting edge of Disorders of Gut-Brain Interaction for nearly 40 years! A professor of both gastroenterology and psychiatry and the author of over 500 peer-reviewed scientific articles, Dr. Drossman was the founder of the Rome Foundation that provided the framework that we currently use for the treatment of these disorders.

I personally was mentored by Dr. Drossman during my gastroenterology fellowship at the University of North Carolina. I have fond memories of my time in his clinic, an experience unlike any other clinic that I’ve ever worked in. We had a multidisciplinary team of therapists, psychologists, eating disorder specialists, and gastroenterologists working with patients who were suffering with complex digestive disorders, whose testing had all been negative, had been told by other doctors that there was nothing that could be done for them, and who felt hopeless. Unlike the traditional medical model, we would invest hours into each individual patient, and it was absolutely incredible to witness a transformation that would take place before our eyes as you would see a glimmer of hope appear in their eye, optimism that they could in fact get their health back, and a plan develop for how to do it. The care of these patients can be intimidating when you don’t feel like you have the tools to help them.

But now, finally, patients, providers and the general public can have those life transforming tools. In Gut Feelings: Disorders of Gut-Brain Interaction (DGBI) and the Patient-Doctor Relationship, Dr Drossman and Johanna Ruddy provide the comprehensive knowledge and scientific explanations that will allow us all to understand how best to diagnose and treat those suffering with DGBIs like IBS, functional dyspepsia, constipation and chronic abdominal pain. This book is a must own for providers and patients alike in their quest to optimize digestive wellness!

Will Bulsiewicz, MD MSCI
New York Times bestselling author, Fiber Fueled
This is an essential read for all clinicians working with Disorders of the Gut-Brain interaction, which arguably includes all clinicians, given their rising prevalence in society. Dr Drossman is leading the way in patient-centered care, which is essential to empower our patients and help them better understand and manage what can be an incredibly debilitating cohort of disorders.

Megan Rossi PhD, RD APD
The Gut Health Doctor
This book is a "must-read " for anyone who is in the health care world and who takes care of patients - especially those who see patients with IBS, or in the current vernacular Disorders of Gut-Brain Interaction (DGBI). This book is a true vade mecum (Latin: go with me), a handbook or guide that is kept constantly at hand for consultation. It is chock full of wisdom about doctor-patient relationships and can only serve to improve one's interviewing skills and therapeutic goals. Of great use are the supplements , especially the one on Clinical Programs for DGBI listing where one can get the help that is so often needed in managing the "difficult" patient. We need such guidebooks for all diseases and Dr. Drossman and Johanna Ruddy have provided an outstanding construct for how they should be done. 

Lawrence J. Brandt, MD, MACG, AGAF, FASGE, NYSGEF
Professor of Medicine and Surgery
Albert Einstein College of Medicine
Emeritus Chief, Division of Gastroenterology

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