The practice of medicine is rapidly transforming through the implementation of technical innovations and facilities. These have led to more accurate diagnoses and therapeutic innovations, but they also require new skills from physicians and have profoundly altered the doctor-patient relationship. Computer screens now occupy the space between the patient and doctor, apps monitor health parameters, and websites provide information on health, diseases, and treatments. Through these innovations and primarily because of the increasing time pressure on physicians and other healthcare providers, time devoted to the doctor-patient interaction has dramatically decreased. While healthcare spending increased more than 20-fold over the last decades, the average office visit time dropped by almost 75%. These numbers might raise the impression that direct interaction between patients and doctors is not so important after all. In a technology-driven view on medicine, the power is in numbers and images reporting test results, and anything beyond these aspects is redundant.
There is ample evidence of the opposite: effective communication between doctors and patients remains the cornerstone of disease management. While technology and the vast medical knowledge basis determine the accuracy of the diagnosis and the evidence base for the treatment plan, the communication secures the trust and engagement of the patient in the process, both short- and long-term. It also provides a basis for acceptance of side-effects or less satisfactory outcomes. For the doctor, there are also benefits related to good communication with patients, including enhanced job satisfaction and prevention from burn-out.
The role of effective patient-doctor communication is of even higher importance in disorders lacking diagnostic tests to make the diagnosis, such as the disorders of gut-brain interaction, previously referred to as functional gastrointestinal disorders. We define these conditions by a constellation of symptoms, the Rome Criteria, in the absence of a measurable diagnostic marker. Recognition of the symptom pattern to establish a diagnosis depends entirely on good history taking, which depends on a good patient-doctor relationship. Furthermore, it is well documented that after communicating the diagnosis, the quality of the patient-doctor interaction is a determinant of positive long-term outcomes.
In this book, two eminent experts, on either end of the patient-physician relationship, build on their personal experience and knowledge to express their views on patient-centered care. The framework for their description of the pivotal role of good-patient-provider communication is that of the disorders of gut-brain interaction. Johannah Ruddy, who wrote the patient perspective aspects in this book, is the Executive Director of the Rome Foundation, an independent not for profit organization whose mission is to improve the lives of people with disorders of gut-brain interaction. This function, with the explicit focus on patient benefit, already puts her in an authoritative and privileged position to reflect the patient perspective. As is clear from her candid testimony in the book, she has also personally experienced the harmful effects of a callous physician-patient interaction in a setting of debilitating chronic abdominal symptoms. Her extensive negative experience in interacting with the medical field took a dramatically favorable turn after consulting with Dr. Douglas Drossman. From that role, she experienced a lack of stigmatization, learned that the symptoms were taken seriously, and engaged in a quality patient-physician interaction. These fundamental elements led her to gain control of the symptoms that had dominated her life for a decade.
Dr. Douglas Drossman, who wrote the physician sections of this book, is the founder of the Rome Foundation. He was instrumental in enabling the current recognition of disorders of gut-brain interaction as relevant clinical entities instead of older views of these entities as “imagined” or “not worth treating.” Under his guidance, the Rome Foundation published diagnostic criteria and contributed considerably to the current concepts of these disorders, and how they can be diagnosed and managed in clinical practice. He also contributed descriptions of the major disorders of gut-brain interaction and how they are diagnosed and treated in the book. The Rome Foundation does not only advocate state-of-the-art classical pharmacological therapies targeting the gastrointestinal tract. It also advocates the appropriate use of neuromodulators and behavioral or psychological treatments for these conditions.
While the book is written focusing on disorders of gut-brain interaction, its content has relevance to medicine in the broad sense. The importance of quality communications in medicine is not restricted to the gastroenterology field. Hence, the sections on how to use communication skills to optimize the patient-doctor relationship (and expandable to the patient-healthcare provider relationship) are of interest to anyone active in a healthcare setting. The recommendations and learning points address not only verbal communication but also the non-verbal aspects of the patient-physician interaction. The recommendation section ends with 14 action points for daily practice. The book also gives guidance to patients on how to express themselves and what they can do to get the most out of patient-healthcare provider encounters.
My hope for the future is that the non-technical aspects of the patient-doctor encounter gain recognition for its merits and value. The book, “Gut Feelings: Disorders of Gut-Brain (DGBI) Interaction and the Patient-Doctor Relationship. A Guide for Patients and Doctors.” is an indispensable companion for providers as well as patients, who want to improve the quality and outcomes of health care. I applaud the authors for an outstanding and impressive book, and hope you will find an enjoyable and enriching reading experience.
Jan Tack, M.D., Ph.D.
President, Rome Foundation
Head of Gastroenterology and Hepatology Division, Leuven University Hospitals
Professor of Medicine, Leuven University