Effective healthcare provider-patient communication is essential when building a therapeutic relationship. This is important in the delivery of high-quality health care. The healthcare provider-patient relationship can be complex. Typically, the patient enters into this relationship in a distressed state and wants to be made more comfortable as well as emotionally and spiritually relieved by the outcome of the interaction.
Healthcare provider-patient communication with FGIDs
First, functional GI disorders are characterized, in most cases, by vague symptoms of variable intensity. Many times, these symptoms involve the most intimate anatomic areas of the body. This can make it difficult for the patient to express their symptoms and also difficult for the provider to formulate a diagnosis.
Secondly, without obvious structural lesions it is difficult to find a specific medical intervention that is successful. In some cases, the provider’s own anxiety can be increased by the lack of a symptom complex that leads to well-understood disease entities, such as parasites or lactose intolerance. This deficiency, in turn, often leads the provider and patient to over-investigate the symptoms.
So what are some things that comprise successful healthcare-provider communication about functional GI disorders? Patients can help their provider by describing their complaints as accurately and as concisely as possible.
Providers should always ask these questions:
- Where’s the pain?
- How long have you had the pain?
- Is the pain going any place else?
- What makes the pain better or worse?
Having fairly precise answers to these questions can be extraordinarily helpful in formulating a working diagnosis. Healthcare providers describe their initial history-taking as the “history of the present illness.” And this phrase means just that they like to start out with the complaint as currently perceived.
What the pain was like months or years ago is less helpful. If your symptoms fluctuate, keep a diary of them and the activities in your daily life that are associated with exacerbation or relief of GI symptoms.
Important clues, which are oftentimes subtle, can become apparent in the course of journal keeping over a few weeks.
Alleviation of concerns is uppermost in a patient’s mind when visiting a provider. However, many times, the concerns of the patient are dramatically different from those of the provider.
It is absolutely critical that you clearly and directly voice your concerns. “Could I possibly have cancer?” or any other question that is prompted by fear should be immediately brought to their attention. The phrase, “There are no stupid questions,” always applies in the provider’s office.
If you feel devalued or ignored when you raise emotionally loaded questions, you should consider changing your healthcare provider. The intangible chemistry between the healthcare provider and patient is critical to any successful therapeutic endeavor. If you do not feel comfortable or your needs and concerns are not being met, change to another one.
Functional GI disorders many times demand that a healthcare provider take a history of very intimate areas of your life that center around bodily elimination and sexual functioning. If the patient is female and the provider is male, we have found it extremely helpful for a female assistant to be present during the history taking and always present for the physical examination.
If such techniques can make you as a patient feel more comfortable, make your desires known. It is rare that these accommodations and requests is denied. Again, you need to ask.
A very sensitive area of inquiry concerning past experience with physical or sexual abuse presents a special challenge to both patient and provider. This area is important to explore because numerous studies have shown that childhood physical or sexual abuse is frequently accompanied by the development of significant bowel dysfunction in later life.
Psychotherapy, both individual and group, and peer support groups, can be extremely helpful in relieving the pain associated with these traumatic experiences. But this information needs to be known before solutions can be sought. The decision about when and how to reveal this information is entirely up to the patient.
A critical period of communication occurs at the end of any office visit. Healthcare visits are universally stressful for patients. (I can vouch for that; remember all healthcare providers have been patients at one time, too!)
Healthcare visits should always end with treatment recommendations that are fully detailed. These recommendations often include instructions on how to prepare for diagnostic tests, descriptions of medications and their side effects and directions on modifying your diet.
The quantity of information can come as a torrent to a patient who has just endured a lengthy history taking and physical examination. To compensate for feeling overwhelmed, write down the recommendations.
If you do not understand them at first, ask your healthcare provider to repeat them. If you still need extra support, the provider or an assistant is usually more than willing to spend time after the formal visit going over the details of treatment.
Remember, it is to the healthcare providers advantage to have a patient who is properly following the treatment recommendations. Many provider offices offer written information on topics such as proper nutrition and medications and their side effects.
You can also obtain IFFGD brochures or publications about functional GI disorders and other education materials from your healthcare provider. Be sure to ask for any available materials.
Finally, remember that your relationship with your healthcare provider does not end at the door. If questions or concerns arise, call them! Remember, the most successful healthcare provider-patient relationships are those in which both the patient and provider feel comfortable and confident in each other’s ability to communicate.
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Adapted from IFFGD Publication #116 “Doctor-Patient Communication” by Kevin W. Olden, MD, Asst. Clinical Professor of Medicine and Psychiatry, Mayo Medical School, Scottsdale, AZ