Time to drop the kind of, sort of, maybe from IBS

IBS

By Mardi Chapman

5 Oct 2017

Clinicians including specialists and GPs need to check their language and behaviour around a diagnosis of IBS.

According to a review in the Medical Journal of Australia, IBS is not handled well in the health system leading to ‘frustration and dissatisfaction in patients and doctors alike’.

Co-author Professor Jane Andrews, head of IBD services at the Royal Adelaide Hospital, said there was evidence specialists were dithering around with uncertain language in letters back to GPs.

She told the limbic they were ‘using tortuous language to weasel out of committing to a diagnosis’.

However the same did not apply when communicating about organic gastrointestinal conditions such as peptic ulcers, Crohn’s disease and reflux.

“Culturally we have a block with functional gut symptoms. There are a number of other areas where we don’t have ‘a test’ but we can make a diagnosis,” she said.

“If they have talked to the patient and performed some simple investigations, then what else could it be?”

Professor Andrews said she was being deliberately provocative but clinicians had to reflect on the language they were using when communicating with colleagues and patients.

“With a clear diagnosis, some reassurance and an explanation, many patients can manage on their own.”

However patients who didn’t feel they were getting a consensus on their diagnosis or were being sent for new tests at every visit, were likely to become increasingly anxious.

She wrote in the MJA that a well-made clinical diagnosis of IBS was safe and reliable.

“A clear diagnosis provides reassurance and alleviates patients concerns and helps move the patient from a diagnostic search to an effective management strategy, which, in turn, reduces the physical and mental distress of patients and the economic burden due to impaired workplace productivity, unnecessary investigations and endoscopic procedures.”

Professor Andrews reiterated her support for reimbursement of faecal calprotectin tests to help discriminate between patients with IBS and those who might warrant specialist referral.

She added the vast majority of patients with IBS could be dealt with in primary care settings including GPs, dieticians for advice and support with low FODMAP diets, and psychologists for gut-directed psychotherapies.

“It is not sensible or affordable for IBS to be dealt with by specialists.”

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