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.

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

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.

Professor of Medicine

Mayo Clinic, Jacksonville

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.

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.

Director, Center for Gastrointestinal Motility, Esophageal, and Swallowing Disorders

Assistant Professor of Medicine and The Dartmouth Institute

Section of Gastroenterology and Hepatology

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. 

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.”  

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. 

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.

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

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. 

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! 

Associate Professor of Clinical Medicine

Chief, Division of Gastroenterology and Hepatology 

Renaissance School of Medicine at Stony Brook University

Emeritus Professor of Primary Care and General Practice, Newcastle University, UK

Committee Member, European Society for Primary Care Gastroenterology

The authors of Gut Feelings, Doug Drossman and Johannah Ruddy, have compiled personal accounts of eight patients with disorders of gut-brain interaction (DGBI) as a sequel to their original publication. The new book, Gut Feelings: The Patient’s Story, includes commentaries by both authors to complement the description and temporal course of each patients’ journey toward symptom control. Through the course of the commentaries, concepts underlying DGBI and their management are consistently explained, masterfully using each patient’s clinical scenario as a living example. 

Each patient story follows a standard set of questions regarding the patient background and upbringing, illness onset and course, interaction with health care as part of the illness journey, and finally, where they are now with their symptoms and their life. Video links lead to each patient’s description of their story in their own words. One of the patients highlighted is Johannah Ruddy herself, as she opens up about her frustrations with her DGBI symptoms and with the health care system, until she landed a job with the Rome Foundation, and her husband convinced her to consult with Doug Drossman as a patient. Each patient has similar themes in their story, with initial frustration, suffering and reluctance replaced by hope, empowerment and clinical improvement through diligent, thorough and in-depth evaluations by Doug Drossman. Johannah Ruddy provides insightful commentary from the patient’s angle, and fills in tidbits and details that enhance the reading experience. Each commentary ends with take-home messages that highlight salient points regarding each patient and DGBI diagnosis. 

Gut Feelings:The Patient’s Story is written in the same easy conversational tone as the first book. The patient’s initial frustrations can relate to any symptomatic patient with DGBI, and can be an eye-opener to how perceptions matter when physicians and the health care system interact with DGBI patients. The intricate relationships and interactions between DGBI and affective disorders are well highlighted, and the reasoning underlying medication or therapy choice are clearly explained, taking the patient’s psyche into consideration. Similar to the first book, there is a listing of US and international centers with expertise in evaluation and management of DGBI. In all, Gut Feelings:The Patient’s Story is a solid complement to the initial publication, with illustrative examples that will be of immense value to any stakeholder in the evaluation and management of DGBI, including the patient. As with the first book, this is a must-have for not just trainees and practitioners within the DGBI sphere, but also anyone who suffers from DGBI who wishes to gain further perspective into their condition and its management.

Washington University St. Louis, MO