Why can’t doctors and patients understand each other?

By Dr. Charles Gerson

This initial blog will discuss an article entitled “Do We Know What Patients Want? The Doctor-Patient Communication Gap in Functional Gastrointestinal Disorders.” The article was written by Collins J, et al. in Clinical Gastroenterology and Hepatology, November 2009. (You can download the complete article here.)

In this research project, patients and physicians were both asked to estimate the severity of the patient’s symptoms after the initial consultation. 48% of the physicians underestimated the patient’s self-assessed level of pain, 41% underestimated the degree to which patients’ symptoms affected their lives, 41% underestimated symptom frequency and 82% underestimated the number of symptoms that bothered the patients.

What is important about this article? We have seen many patients who complain that a doctor performed a number of tests with normal results and basically told them they were ok, when they were suffering from a number of gastro-intestinal symptoms. Patients feel even more discouraged after the visit.

What is our interpretation of the findings? Conversations between physicians and patients are often problematic. How? Physicians often interrupt patients while they are explaining what is bothering them because they have been trained to focus on making a diagnosis, based on general categories. They’re not trained well enough to listen to specific, individual aspects of a patient’s illness once they think they know the diagnosis. When a patient describes symptoms that seem vague or detailed, physicians can become anxious and impatient.

What can patients do? Patients should be mentally prepared for the initial interview. We recommend that patients be prepared to give a focused history: their main complaints; any previous evaluations; copies of test reports and a list of current medication can be helpful. However, with an illness like IBS, there is no substitute for a physician who is sensitive to the interplay between the life of the patient, including any emotional issues, and the physical symptoms they are experiencing.