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