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Gut Feelings: The Patient's Story

“Gut Feelings – The patient’s story” follows and expands the previous book of Dr. Drossman and Ms. Ruddy, on “Disorders of Gut-Brain (DGBI) Interaction and the Patient-Doctor Relationship”. The first book presented important perspectives on the doctor-patient relationship in Disorders of Gut-Brain Interaction, illustrated by the Ms. Ruddy’s personal patient experience.
In this follow-up book, the focus is on the individual narratives of eight patients, who experienced a difficult journey through the healthcare system after presenting with chronic symptoms of DGBIs. Unfortunately, they experienced a lack of understanding, patience or time commitment when presenting to different healthcare providers, only leading to further aggravation of the disease impact. Each case is well-described, and then put into perspective by Dr. Drossman, a world-renowned expert on these disorders and on physician-patient communication, and by Ms. Ruddy, a well-known and experienced patient advocate.
Most healthcare professionals are motivated by the fascination for the functioning of the human body in health, the rapidly evolving science on how dysfunction causes illness and the ability to reverse disease and the prospect of making a difference in other people’s lives. The time pressures and busy schedules of a professional healthcare provide can be so overwhelming that the key aspect of taking care of patients, which includes sufficient time and commitment for interaction, can get lost. The book, both in the patient narratives and Dr. Drossman’s comments, offers multiple learning and introspection opportunities for the “too busy” clinician. In addition, it includes clinical/scientific pearls and illustrations on disease concepts, symptom generation, patient-centered management and the use of neuromodulators when treating DGBIs.
The book also provides relevant first-hand experience to patients with DGBIs, who can learn from these testimonies how to look for and how to communicate with the healthcare provider to obtain good and appropriate medical care. This is summarized in five key-take aways for patients in the Epilogue of the book.
Healthcare providers and patients with DGBIs, but also with other difficult to manage chronic conditions, will benefit from reading this book, which will improve their mutual interaction and understanding, leading to better health outcomes.

Jan Tack, M.D., Ph.D.
President of the Rome Foundation for Disorders of Gut Brain Interactions (DGBIs)
Head, Division of Gastroenterology and Hepatology, Leuven University Hospitals
Professor of Medicine, Translational Research Center for Gastrointestinal Disorders (TARGID)
Department of Chronic Diseases and Metabolism, University of Leuven
Visiting Professor, Institute of Medicine, University of Gothenburg, Sweden

As a gastroenterologist, I have been managing patients with functional abdominal disorders for years. In the field of functional abdominal disorders, Dr. Douglas Drossman, one of the founding fathers of Rome Foundation, needs no introduction. We often refer to Rome criteria for making a diagnosis of irritable bowel syndrome, functional dyspepsia, or myriad of other disorders of gut-brain interaction (DGBI). However, reading about DGBI in the first Gut Feelings book, the concepts of biopsychosocial model and about how to achieve and maintain a good patient-doctor relationship through effective communication was an eye opener.

The latest Gut Feelings: The Patient’s Story, is based on the personal experiences of eight patients with DGBI. Each story is unique and takes the readers through these patient’s long and difficult journey from onset of symptoms to diagnosis and the frustrations they experienced and finally, how with the help of Dr. Drossman and his team, they learned to cope and manage their symptoms. At the end of each story, Dr. Drossman, systematically describes the patients’ medical journey and takes us though the thought process behind choosing a treatment plan. He explains in detail about what gut-brain neuromodulators were suggested and why. Finally, the patients’ experiences are further highlighted by the co-author, Johannah Ruddy, who is a strong patient advocate. Her own medical journey as a patient with DGBI is narrated in one of the book chapters. She aptly, helps explain the patients prospective and points out the common communications errors that we often, unknowingly, tend to commit. Overall, this book will tremendously help both the healthcare providers as well as the patients who goes through similar experiences on daily basis and can learn to better understand DGBI and even more importantly, better communicate for a successful outcome.

Ajay Rana, MD, MCTR
Associate Professor
Pediatrics Gastroenterology
University of Rochester Medical Center
Rochester, NY

It is not every day that one finds a rare book - equally suited and equally beneficial for both patients and clinicians alike.
"The Gut Feelings: The Patient's Story" is more than case-based learning.
Each chapter's center is an uninterrupted, uncensored patient story. Storytelling, often discouraged in modern medical practice yet essential for "good medicine," provides invaluable diagnostic and therapeutic clues. Simultaneously, the experience of telling and receiving the story builds the patient-clinician therapeutic relationship. This relationship is essential for the patients to get better and clinicians to experience job satisfaction.

I do not doubt that reading this book is therapeutic for the patient reader, who can associate with others' stories, feel validated, and gain knowledge and hope. Perhaps less obvious is that a clinician reading the book can also experience unexpected therapeutic benefits from reading patients' narratives. The narratives can renew empathy and reconnect clinicians with the meaning of the medical profession, effectively offering an antidote to ever-so prevalent burnout.

Apart from its therapeutic effects, the book is unique in bringing together a three-fold perspective – the patient, clinician, and patient advocate, thus promoting thought-provoking in-depth learning. This approach allows us to appreciate the complexities of the illness experience and the multilayered, yet achievable therapeutic approach needed to improve patients' lives.
Following Dr. Douglas A. Drossman's, therapeutic decision-making, a leading expert in DGBIs is remarkable. Imagine spending a day with a master clinician and communicator in his exam room, learning clinical pearls one cannot find in GI textbooks. At the end of each chapter, Mrs. Joahannah Ruddy's insightful comments bring us back full circle to what matters- the patient illness experience as a perfect closing.
An excellent book for anyone who would like to learn about the patient experience of IBS or other disorders of gut – brain interaction and for the clinicians who aspire to master the science and art of treating DGBIs

Albena Halpert, MD
Gastroenterology
Harvard University Health Services
Cambridge, MA

Pardon my excitement, but this is a terrific sequel book that meets a real unmet need. Coming on the heels of the first book, which was more informative in nature, this book is experiential and moving. The patients who provided their stories are remarkable in their willingness for total exposure including photographs and voice recordings, which make their story real, personal, and compelling. These are in depth reflections of what patients feel and go through as they navigate the healthcare system with symptoms and test results that are often disparaged by doctors and other providers rather than legitimized. It always amazes me that doctors can tell patients who suffer so much that “nothing is wrong with them” just because their test results are “normal.”

Following the in-depth narratives come the superb comments by Dr. Drossman, who not only treated and is treating these specific patients but has devoted his entire professional career to legitimizing them. He finds these patients challenging, in the best sense of the word, rather than difficult and derives great satisfaction from working with them toward the shared aim of improved function and quality of life. Indeed, he cares for the patient who has a problem, not just the problem. Then we get the special insights of Mrs. Ruddy who has the triple perspective of a patient (in fact she is one of the patients presented in the book), a patient advocate, and Rome Foundation Executive Director. All doctors should benefit from these insights.
This is a unique and special book and I highly recommend it to patients and their friends and families, and doctors and other healthcare providers.

Ami Sperber MD, MSPH
Professor Emeritus of Medicine
Faculty of Health Sciences
Ben-Gurion University of the Negev
Beer-Sheva, Israel

I pause in awe after having read these 8 patient accounts of their gut disorders and abdominal pain in Gut Feelings: The Patient’s Story. I wish I had realized earlier what Johannah has seamlessly described here in my medical practice as it would have undoubtedly improved many interactions with my similarly courageous patients who experience chronic gut symptoms impacted by their traumatic life experiences.

To fully embrace Dr. Drossman’s very deliberate teaching in this book, one must drink it in slowly as you would the finest of wines. You need both time and experience to perfect his art, but I feel this book has already transformed me into a better clinician. Moving thru this book’s chapters challenges me to see things from the patient’s viewpoint and to better understand the kaleidoscope of each patient’s biopsychosocial construct. The disconnect between patients’ symptoms and diagnostic testing is cleared up beautifully in this monumental work embarking on us to let the patient talk and thereby lead a patient-centered practice of medicine despite all the time constraints put forth by our dysfunctional healthcare system.

Baha Moshiree MD
Professor of Medicine and
Director of Motility
Division of Gastroenterology
Wake Forest University – Atrium Health
Charlotte, MC

Dr. Doug Drossman’s and Ms. Johannah Ruddy’s earlier book, Gut Feelings: Disorders of Gut-Brain (DGBI) Interaction and the Patient-Doctor Relationship—A Guide for Patients and Doctors, nicely sets the stage for this sequel. The initial book provided the important understanding for physicians and patients about what DGBI represents. It focused on the conceptual, physiological, and medical aspects of DGBI, at the same time underscoring the central role of communication and establishing the clinician-patient relationship. To achieve the latter, they effectively used a focus on Dr. Drossman’s and Ms. Ruddy’s highly successful relationship as doctor and patient, respectively.

This new book responds to many readers’ desires for more stories of patients with DGBI. It provides detailed descriptions of 8 other patients of Dr. Drossman. Their stories feature diagnoses varying from irritable bowel syndrome to constipation to anxiety to interstitial cystitis to fibromyalgia to migraine to sexual (and other types of) abuse—often with many diagnoses occurring together. And these problems had become disabling not only from the disorder itself but also from the uncertainty of their diagnoses and from the strained, often stigmatizing relationships that sometimes evolved with earlier providers.

Each patient’s case begins with their own rendition of it. Dr. Drossman’s and Ms. Ruddy’s commentaries follow. The former includes some easily understood diagnosis issues and explanations of the biological mechanisms underlying the problem. He then emphasizes treatment principles, reassuringly highlighting that his care is not unique, rather that it follows biopsychosocial principles available to all clinicians. Ms. Ruddy’s comments merge her personal understanding from a patient’s perspective with a very informed professional perspective she has developed as a result of her work in DGBI as a patient advocate.

The often poignant patient stories and their eventual successful resolution—although often without actual cure—provide the highlight, especially for the lessons they learned, the importance of hope, and the central role of a strong doctor-patient relationship to their well-being.
An added benefit from this wonderful book is a link to a digital recording of each patient recounting their story, in some instances conducting a conversation about their illness with Ms. Ruddy and Dr. Drossman.

While this book will have great appeal to patients with complex problems, it also will be of value to clinicians caring for these patients, not only to appreciate the travails their patients experience but also to identify some treatment measures they might themselves embrace in the future.

Robert C. Smith, MD, MACP
University Distinguished Professor of Medicine and Psychiatry Emeritus
Michigan State University, College of Human Medicine

Dr. Drossman and Ms. Ruddy have done it again. Gut Feelings: The Patient’s Story: Personal Accounts of the Illness Journey affords patients and practitioners alike a window into the complex roads patients often travel to obtain appropriate care. In this book, eight patients experiencing disorders of gut brain interaction with complex overlapping medical and psychosocial conditions provide honest, real, and raw details of resilience in their quests to obtain appropriate medical diagnoses and care. These testimonials, free of medical jargon, provide insight into their journeys focusing not only biological symptoms but the impact of these symptoms on their perceptions of themselves and the medical community. Importantly they also offer a window into the impact of these disorders on their daily functioning, quality of life, and relationships with family and friends. Ultimately, through regular interactions, interdisciplinary care, and relationships forged with Dr. Drossman, common threads are identified—a strong need for self-advocacy, never settling for the status quo, a sense of personal empowerment, the need to see individuals not as illness but biopsychosocial entities, and a renewed belief in the medical system. Another key facet of this book which will resonate with individuals with disorders of gut brain interaction is the commonality of experiences and a realization that they are not alone in this process. There is hope for improved care and recovery.

Gut Feelings: The Patient’s Story: Personal Accounts of the Illness Journey is also a superb resource for practitioners who see and/or shy away from these patients due to feelings of frustration and/or an inability to appropriately intercede. Dr. Drossman and Ms. Ruddy walk us step-by-step through every-day care techniques ranging from open-ended history taking to identification of important patient-centric outcomes unifying common goals through established trust and collaborative decision making. The reviews of the patients’ histories by both Dr. Drossman and Ms. Ruddy are presented in a concise manner with commentary and discussion supported by clinical evidence presented in easy to review tables and figures and further substantiated via online links to enduring educational content. Gut Feelings is a quick but poignant read that I would strongly recommend for all practitioners.

Darren M. Brenner, MD, FACG, AGAF, RFF
Associate Professor of Medicine and Surgery
Irene D. Prtizker Foundation Research Scholar
Director—Northwestern Neurogastromotiliy Program
Northwestern University Feinberg School of Medicine

As a specialist on DGBI, I often hear my patients recount their difficult and challenging healthcare experiences with chronic illness. After reading “Gut Feelings: The Patient’s Story”, I am sad but also impressed by these patients’ stories: the bitterness of their illness journey and the need for physicians to take the time to listen and not be so quick to dismiss their patient’s symptoms. Indeed, physicians would be inspired to do better for DGBI patients after reading the stories from this remarkable book.

Xiucai Fang MD
Department of Gastroenterology
Peking Union Medical College Hospital
Beijing, China
For more than 30 years I've followed the works of Professor Douglas Drossman. I read them and I use them in my practice and teaching activities. Among these, the papers and books focusing on the improvement of the relation between healthcare providers and patients are innovative and useful. After reading with attention the first volume “Gut feelings”, I was impatient to browse through the second volume.
“Gut Feelings: The Patient's Story: Personal Accounts of the Illness Journey “ is the logical sequel of the previous one. In the first book, patients and health care providers could find a syllabus on the disorders of gut-brain interaction. We also learned through Johannah Ruddy, the co-author of the book information her illness experience and the value of communication skills and the patient-doctor relationship .
The present new book is dedicated to and for the most part written by patients. Professor Drossman, in collaboration with Johannah Ruddy, reassembled the stories of eight patients with different disorders of the gut-brain interaction and complicated medical issues. The narratives provided by these patient remind me of the excellent videos produced by Drossman Center, where we can learn how to approach and improve the care of these patients. Indeed, reading each of the stories and the following comments and explanations, by Dr. Drossman and Ms. Ruddy, we can better understand the patients illnesses and better approach their care.

This book is not simply a collection of stories, but a must-read textbook for all healthcare providers wishing to truly understand and to do more for their patients who suffer with digestive and somatic functional disorders,.

Prof Dan L Dumitrascu
2nd Dept. of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca; Cluj County Clinical Emergency Hospital, Romania
President EAGEN
Chairman National Societies Committee UEG

The patient-physician experience is unique. During this encounter the patient is asked to describe symptoms leading to the visit, some of which may be mildly bothersome while others are worrisome or even life-altering. These symptoms may cause not only physical discomfort but emotional distress as well. This privileged conversation is confidential, allowing the disclosure of intimate details. During this conversation, a high level of trust must be present from both parties. The patient must trust that the health care provider is listening and comprehending their story, while the practitioner must trust that the full story, with all relevant details, is being told. Theoretically, this privileged conversation should be easy, with a bidirectional flow of information that leads to the correct diagnosis and a personalized treatment plan. However, these conversations are increasingly less than ideal, leading to frustrated patients and disgruntled providers. The reasons why patient-provider interactions are not uniformly positive is multifold, but include increased patient volumes, decreased time allotted for the patient visit, increased requirements for time-consuming administrative tasks and documentation, and greater patient expectations regarding testing and treatment. Given these multiple potential issues, it is not surprising, but still disappointing, that the patient-physician experience can be less than ideal for some patients.

Improving the patient experience is critical, however, as a better patient experience leads to better patient care, improved patient outcomes, and a reduction in healthcare stress and burnout. In this new book, “Gut Feelings: Patient Stories” Drossman and Ruddy provide critical information on ways to improve the patient-provider experience. Using a series of artfully crafted patient vignettes the authors provide essential information on ways to improve communication, listen more carefully, appreciate the patient perspective, sort through complex diagnoses, understand the impact of disorders of gut-brain interaction (DGBI) on patients, and understand the role of early life stressors and events. Understanding the journey of these eight patients, and using lessons learned from their interactions with the health care system, Drossman and Ruddy provide sage advice on how to better explain the underlying complex pathophysiology of DGBIs, discuss conflicting diagnoses and overlapping diagnoses, and review the array of currently available treatment approaches, all the while using an interactive shared decision making model.

This book fills an important void in the medical literature for both health care providers and patients. It provides valuable information from the patient perspective and thus will be instructive to health care providers of all specialties. Just as importantly, patients will find a wealth of critically useful information to help make their visits more effective and to understand the complexity of diagnosing and treated disorders of gut-brain interaction.

Brian E. Lacy, Ph.D., M.D., FACG
Professor of Medicine
Mayo Clinic, Jacksonville

“Gut Feelings: The Patient’s Story” by Dr. Douglas Drossman and Ms. Johannah Ruddy is a first of its kind publication that takes us through journeys of patients with complex neurogastrointestinal disorders. The work provides a “personal dimension” of the suffering experienced which is often hard to appreciate in conventional biomedical literature. This writing is only possible in the hands of an expert like Doug who has provided biopsychosocial care to complex patients for over four decades and Johannah who has personally suffered from post-infection irritable bowel syndrome and is leading the Rome Foundation, the largest international organization for research and care for patients with disorders of gut-brain interaction (DGBIs).

The stories are a powerful reminder of how these disorders evolve and wreck our patients’ lives. They are also a reminder that our conceptual understanding can often be over-simplistic and quite often, 3-4 disorders and concomitant psychosocial dysfunction are experienced by our patients. From my perspective, it was instrumental to see how the patients understood these disorders and how they articulated what matters to them the most. It is instructive to see that providers’ empathy, validation of symptoms and relationship with the patient remain the pillars for care for our patients.

The stories also brought home the unmet need for more effective treatments. As we further design mechanistic studies and clinical trials, we need to take these stories in perspective as they educate us a lot about what is important for the patients and tell us to be more pragmatic in our approach. I believe this book should be a must read for us who care for these disorders and for regulatory and funding agencies that make critical decisions that will guide how the future landscape of DGBIs will look like. The authors are to be commended in their efforts in bringing out patients’ perspectives and patients to be thanked for their openness.

Madhusudan Grover MD
Associate Professor, Departments of Medicine and Physiology
Consultant, Mayo Clinic
Rochester, MN

Following the publication of “Gut Feelings: Disorders of Gut-Brain Interaction (DGBI) and the Patient-Doctor Relationship”, Dr. Douglas Drossman and Mrs. Johannah Ruddy, are publishing the book “Gut Feelings: The Patient's Story-Personal Accounts of the Illness Journey”. Dr. Douglas Drossman is a worldwide expert in DGBI and probably the father of this field, and Mrs. Johannah Ruddy a patient herself and a patients advocate.

The book includes stories told by eight patients who have transitioned from suffering diverse DGBI, to health. Their accounts are a testament of the difficulty in navigating through the healthcare systems, trying to find a healthcare provider that really understands DGBI, validate their symptoms and be able to help them; a story that I experience every day in my clinical practice. Each case is complemented with a clinical commentary by Dr. Drossman, interpreting and explaining the case from a medical standpoint, usually including a cartoon depicting the underlying mechanism for the subject’s symptoms. In addition, Mrs. Ruddy’s includes a commentary from a patient’s point of view, giving some important points to learn.

Although I live and work in Mexico City, I usually recommend the first book to my English-speaking patients, and when consulting them next, they return very excited because: “for the first time they read something serious that explains what they have…”. With that experience, I am sure that this new book will be as helpful as the previous one, as they will find that they are not alone. Also, learning from other patient’s experiences, will help them to realize what they need to know about their illness, what to ask and research when they are diagnosed with a DGBI, and how they can help themselves.

Max Schmulson, MD
Professor of Medicine
Faculty of Medicine, Universidad Nacional Autónoma de México (UNAM)
Mexico City

The patient narratives featured in Gut Feelings: The Patient’s Story, Personal Accounts of the Illness Journey, provide a unique perspective on the suffering and challenges that face individuals living with disorders of gut-brain interaction (DGBI). The in-depth look at each patient’s illness journey combined with Dr. Drossman and Ms. Ruddy’s perspectives on the cases provides valuable education for providers working with DGBI patients and is a reminder of the healing effect of a strong patient-provider relationship. I appreciate the authors’ honesty regarding the complexity of these conditions and even though many of these cases did not have a simple solution or complete resolution of symptoms, they all moved towards a place of healing and improved quality of life. This book has tremendous value for patients as well. Individuals with DGBI often feel alone in their suffering due the stigma associated with these conditions and the negative treatment experiences they often encounter in the healthcare system. These stories provide hope and connection for those suffering from similar conditions and encourages patients to continue to advocate for themselves and partner with providers that will work collaboratively in their care.

Sarah Kinsinger, PhD, ABPP
GI Psychologist
Associate Professor of Medicine, Loyola University Medical Center

The patent perspective is critical in medicine. Patients’ lived experiences with their symptoms define not only the names of different disorders of gut-brain interaction and how we treat them, but these experiences play directly into patients’ ability to enjoy quality-of-life. “Gut Feelings: The Patient’s Story, Personal Accounts of the Illness Journey” is an outstanding example to build trust in healthcare by bring readers along on the patient journey and shedding light on the experiences that patients go through to build shared understanding.

Eric D. Shah, MD, MBA, FACG
Director, Center for Gastrointestinal Motility, Esophageal, and Swallowing Disorders
Assistant Professor of Medicine and The Dartmouth Institute
Section of Gastroenterology and Hepatology

In the well-known hymn “Amazing Grace”, the lyric, “I once was lost but now am found” speaks of a religious experience familiar to many. This could also serve as the over-arching theme of the 8 patients who are the subject of this uplifting and inspiring book written by Dr. Douglas Drossman and Johannah Ruddy, MEd. These patients had been lost in the thicket of our current health care system-their symptoms often minimized or dismissed by numerous health care providers who appeared to lack the knowledge, understanding or perhaps the time necessary to understand and manage their illnesses which were not associated with disease markers. Their physicians could have been characterized by what Dr. Drossman described, as those “who do not know what they do not know”, or those “who know what they do not know” and who were able to direct them to Dr. Drossman’s clinic in North Carolina. Their outcomes after referral were transformative using the knowledge and principles of care detailed in this book.

Not all patients will be fortunate enough or have the resources to be referred to a physician who is as knowledgeable, dedicated and humane as Doug Drossman. He has been at the forefront of a scientific movement to understand chronic gastrointestinal symptoms which have no disease marker and are now re-named as disorders of gut brain interaction. These disorders are very real and legitimate and it is important to listen to and validate them in order to establish a strong and effective patient-provider relationship, as is illustrated repeatedly by these stories. Through his research, writings, interactions and leadership with like-minded professionals on an international scale, he has had a profound effect on our understanding of these often poorly understood conditions. Doug Drossman is included among certain gastroenterologists who are a “must read” for me; my interactions with Doug and other investigators have made me a more complete and knowledgeable health care provider for patients with gastrointestinal disorders. This is also true for the many educators, clinicians and other providers who have been influenced by Dr. Drossman’s scholarly contributions in this area. As clearly shown in this and other publications, Doug’s work has been immeasurably influenced and enhanced by Ms. Ruddy who, in each case, provides important observations from the patient’s perspective.

This book should be read by anyone in the health care profession who provides care for patients with chronic disorders of brain gut interaction. This recommendation also applies to any health care provider who wants a template for the provision of knowledgeable, dedicated, and compassionate care to patients with complex medical problems. As shown in this book, this often begins with validating symptoms, establishing a strong patient-provider relationship and employing appropriate therapeutic modalities combined with realistic expectations.

Arnold Wald MD
University of Wisconsin School of Medicine and Public Health
Madison, WI

In their new book, Gut Feelings: The Patient’s Story, Doug Drossman and Johannah Ruddy offer an important new resource for the gastroenterology community. Focused on profiling the personal stories of patients with disorders of gut-brain interaction (DGBIs), Gut Feelings offers a wealth of insights about biopsychosocial wellbeing, the opportunities and limits of modern medicine, and the importance of strengthening patient-provider communication. The book profiles eight patients with DGBIs and explores how their illness experiences affect not only physical health, but also psychosocial health. It’s a valuable resource not only for patients with DGBIs, but just as importantly, for their clinicians seeking to improve the care of these common and impactful conditions. 

Brennan Spiegel, MD, MSHS
Professor of Medicine and Public Health
Director of Health Services Research, Cedars-Sinai 
Director, Master’s Degree Program in Health Delivery Science
Cedars-Sinai Site Director, Clinical and Translational Science Institute (CTSI)

This book should be required reading for any health care provider who treats patients with chronic abdominal symptoms, as well as any person who suffers from them. By focusing on the personal account of the illness journey for eight individuals whose gut often malfunctions, Drossman & Ruddy bring a perspective often missing in such books. That is, instead of relying on “normal” scopes, scans, biopsies and other procedures or tests to conclude that “nothing is wrong” with a patient’s gastrointestinal track, they suggest that a professional obtains a patient’s detailed story in an interactive, collaborative patient-centered care partnership to determine what is wrong and how to fix it. In the process we learn about the importance of language (e.g. neuromodulators more accurately describes medicines marketed as anti-depressants) and of focusing on each patient’s strengths and positive attributes, as well as their symptoms.  

Flipping the traditional biomedical model on its head and labeling this array of problems as Disorders of Gut-Brain Interaction (DGBI), associated psychosocial factors are seen as downstream impacts rather than upstream causes. Blame, fault-finding and guilt have no role in the care of any patient. Through eight case studies, each including detailed personal observations by the person who is also the patient, the authors describe how some health care providers may stigmatize, misdiagnose or be unable to “see the forest for the trees”. Their emphasis, however, is on detailing alternative health care provider behaviors that improve patient satisfaction and optimize patient-centered care. In so doing they integrate cutting-edge science and the art of healing captured almost a century ago in the axiom “the secret of the care of the patient is in caring for the patient.”  

Richard E. Kreipe, MD, FAAP, FSAHM, FAED
Professor Emeritus
University of Rochester School of Medicine & Dentistry

Dr. Drossman and Johannah Ruddy have developed a comprehensive “resource” and insightful book called Gut Feelings: Disorders of the Gut-Brain Interaction and the Patient-Doctor Relationship. Outside of providing knowledge on the key concepts that underpin disorders
 of Gut-Brain Interaction, the provider and patient benefit from the insight that exposes the often frustrating gaps in interpersonal communication within clinical practice.  

Whilst comprehensive, the content is easy to read and I am most delighted that the patient and provider are armed with practical  communication tools that serve to empower and improve the clinical experience thus improving patient-centered care and inevitably clinical outcomes.

I have sincere gratitude for Dr. Drossman and all participants involved in the creation of the book, who shared openly and vulnerably. I have observed firsthand the powerfully positive impact of implementing the practices and will share this book with my peers and patients for years to come. 

Lynda Griparic
Gut Health & Weight Loss Health Professional
Naturopath | Nutritionist | Yoga Teacher


Foreword by Joel J. Heidelbaugh, MD

 “I’ve been told that it’s all in my head, I’m making up my symptoms, to stop complaining, to eat right, and even that I should see a psychiatrist about my bowels”. How many times have we heard elements of these statements from our patients? Relative to the myriad of functional disorders and disorders of gut-brain interaction (DGBI) that we encounter, these sentiments should drive healthcare providers to reflect on the nature of the human condition through suffering, disability, pain, and uncertainty. Until now, clinicians have had to rely solely upon their integrated knowledge and experiences in treating patients with DGBI. The literature and lay press are bereft of an adequate account of patient perspectives of diseases that make a sufficient impact to drive innovation in care models.

The most important point this book demonstrates is the power of listening to our patients. Research has embarrassed clinicians by highlighting that on average, we will interrupt a patient in under a minute. The patient vignettes herein are both powerful and truthful. They guide us to be open-minded, non-judgmental, and to create an environment of trust for our patients. Reading this book and the unique personal details of each patient story force me to be introspective about how my language, my tone, and my non-verbal cues can have an impact on a patient. These traits are what drive how a patient will trust me to treat them, or to even come back for another visit.

As a family physician approaching a quarter century of clinical experience in academic medicine, I cherish the ability to always learn from patient stories and perspectives. I am privileged to have co-authored guidelines on irritable bowel syndrome treatment and have lectured to diverse audiences across the country on DGBI. While the scientific literature allows us to understand disease, it is the information outside of what we learn from research and textbooks that allows us to best understand the human elements of people and how to care for them. We often order too many tests, we refer patients around to too many specialists, and we search for cures. Perhaps now we can focus with greater intent on the patient-doctor relationship.

Dr. Drossman and Ms. Ruddy have created a niche in medicine through this book that should garner significant attention. I am indebted to Dr. Drossman for his mentorship through the years and especially of his understanding of how primary care providers can play a significant role in the treatment of DGBI. I am also highly indebted to Ms. Ruddy for her courage in telling her amazing story as a patient, and for challenging me to be a better listener and communicator in my daily practice of medicine. The patient stories herein are more than heartfelt - they are real. This is the angle of education that we clinicians all need to best understand if we are to optimize healthcare for our patients. For premedical and medical students, this book should be a requirement for a foundation in humanism in medicine. While DGBI can’t be cured, they can be validated. And most importantly, our patients can be heard and know that they are not alone.

Joel J. Heidelbaugh, MD, FAAFP, FACG
Clinical Professor, Departments of Family Medicine and Urology
Director of Medical Student Education, Department of Family Medicine
University of Michigan Medical School
Ann Arbor, MI

Gut Feelings – The Patient’s Story: Personal Accounts of the Illness Journey by Dr. Drossman and Ms. Ruddy is a book unlike any other. It is a deeply insightful piece that serves as an incredible resource for both patients who struggle with disorders of gut-brain interactions and the clinicians who seek to help them. To understand the experience and perspective of another, it is crucial to hear their story uninterrupted. In Gut Feelings, patients are given a voice. They share the stories of their illness journeys as well as their origins, their struggles, their fears, and the steps they took to find a path towards healing. Each personal account is complemented with commentary by Dr. Drossman and Ms. Ruddy. Dr. Drossman provides important clinical context and explains his approach to evaluating and treating the individual using a patient-centered model. Ms. Ruddy extends on the patient’s story to provide a deeper understanding of the patient’s experience and the unique factors and traits that helped them overcome the worst of their illness through the lens of a person who has been on “both sides” of the journey; her input is exceptionally valuable and enriching. 

The book will serve as an invaluable tool for clinicians from all specialties as well as a source of inspiration and hope for patients. It is a special combination of patient and provider perspectives. The text is filled with high-yield medical knowledge and guidance on how to understand, identify, evaluate, and effectively treat complex disorders of gut-brain interaction. Simultaneously, the patient is recognized as central and whole. I feel strongly the book will empower both patients and clinicians to bridge their gaps, align their goals, and find the path towards recovery.

Andrea Shin MD
Division of Gastroenterology
Indiana University School of Medicine 


As clinicians, one of our most powerful tools for healing is the patient-provider relationship. The foundation of this relationship is the patient’s story: their experience and perspective of living with a chronic condition. However, we can often feel limited by time constraints and the biomedical focus on diagnostics and treatment. Gut Feelings: The Patient’s Story—Personal Accounts of the Illness Journey provides us with multiple perspectives on how we can use the valuable time we have to truly collaborate with our patients.

The authors, Dr. Douglas Drossman and Johannah Ruddy, have both made tremendous contributions to the field of gastroenterology, particularly in disorders of gut-brain interaction. This book, a follow-up to Gut Feelings: Disorders of Gut-Brain Interaction and the Patient-Doctor Relationship, is another such contribution. Offering compelling and honest patient stories, we gain a deeper understanding of patients’ worlds and the impact of our clinical communication styles. These lessons are augmented by Dr. Drossman’s biopsychosocial perspective to medical management, and Ms. Ruddy’s viewpoint as a patient advocate. This book will surely be impactful for clinicians and patients, helping improve our understanding of DGBIs and helping advance our skills in patient-centered care. 

Meredith Craven PhD
Stanford University Medical Center
When I began reading, Gut Feelings: The Patient’s Story, I was instantaneously engaged, and I remained engaged and craving more until the very last page. As a gastroenterologist who treats patients with Disorders of Gut-Brain Interaction (DGBI), I have heard many patients echo similar sentiments and have struggled with the management of patients with complex gastrointestinal symptoms in my own practice. Hearing perspectives from the patient, Dr. Drossman and Ms. Ruddy, adds unique depth and allows both patient and physician readers to better understand the many nuances involved in the approach to caring for patients with DGBIs. Although we all know that the patient-physician relationship is fundamental to the successful care of patients with DGBIs and truly any illness, modern medicine has, unfortunately, shifted its focus away from effective communication to laboratory, imaging and endoscopic testing. This eloquently written book underscores in plain sight, all the reasons why careful and open-minded listening by the physician and effective communication between patient and physician leads to more successful clinical outcomes and allows patients to lead happier and healthier lives. 

Dr. Drossman is an internationally renowned gastroenterologist who has focused his life’s work on caring for patient’s with DGBIs. The clinical pearls he includes in this book, which are couched in individual patient stories, provide a scaffold for treating patients with various DGBIs and an opportunity for physicians to learn from the expertise Dr. Drossman has garnered over the past 40 years. Although complex pathophysiology and therapeutic management strategies are discussed in this book, the read still remains effortless. Dr. Drossman’s kind, empathic, compassionate and skillful approach to the care of his patients will inspire any physician who reads this book. 

Ms. Ruddy’s perspective on each patient’s story implores physicians to re-focus their attention on the patient experience. Through her words, she reminds us of our own humanity and brings us back into the room with the patient. The strength and courage she consistently portrays throughout this book and her passion for pursuing a career in patient advocacy is an inspiration for patients and physicians alike.  
I will leave you with a final comment…read this now! 

Olga C. Aroniadis, MD, MSc, FACG 
Associate Professor of Clinical Medicine
Chief, Division of Gastroenterology and Hepatology 
Renaissance School of Medicine at Stony Brook University
The heart of the consultation is the interaction between the patient and the doctor. Even as medical knowledge becomes democratized through information and access to the latest thinking on the Internet, the real challenge for the clinician is to retain the confidence of the care-seeker towards a good co-produced outcome. Whilst knowledge, evidence and experience are valuable commodities the central aspect of the care itself is a caring, open and transparent relationship between the patient and their doctor. In this book Doug Drossman, as a clinical expert, and Johanna Ruddy as an expert on herself illustrates how to foster and facilitate a positive and meaningful dialogue with those with DGBIs. DGBIs are an important, frequent and challenging set of disorders for both sufferers and their clinicians. As doctors we often fail such patients and this book commendably and clearly provides help in how to do better. 

Pali Hungin
Emeritus Professor of Primary Care and General Practice, Newcastle University, UK
Committee Member, European Society for Primary Care Gastroenterology

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