IBS is a bunch of BS.
This might sound funny coming from a gastroenterologist, and even more strange when you consider that I’ve only recently come to this conclusion after 17 years in practice. Part of it is related to advances in our understanding of the microbiome and of IBS in general, but a lot of it has to do with my shift from traditional healthcare delivery to a cash pay, Direct Care model, where I’m able to spend more time with my patients.
Irritable Bowel Syndrome used to be a “diagnosis of exclusion.” But it is actually just a description of symptoms.
When patients come in and tell me they have diarrhea, or constipation, that they are uncomfortable, and that these symptoms have been present for at least three months, they earn a diagnosis of IBS. But it’s not helpful to have your symptoms echoed back to you without some understanding of WHY you have them, and what can be done about them.
There are a finite number of diagnoses that cause the symptoms of IBS-d. I can count them on my fingers and a couple of toes. There are even fewer causes of IBS-C (constipation type). They are ruled in or out with a detailed history, some labs, and in some cases a scope and imaging.
In my former career, patients came in and I spoke to them for 15 minutes (which was generous – one patient timed her gastroenterologist and reported 3 minutes of face-to-face time). I asked them about symptoms, or their response to our last intervention, and gave them something new to try or some test to take, to wrestle their diagnosis to the mat. They paid an $80 co-pay and saw me repeatedly.
In my current practice, we speed up the diagnostic process by elongating the visit time. This gives us time to adequately discuss all the details of your symptoms.
Instead of a 30 minute initial visit, I now spend 60 minutes. We talk about symptoms and I use my clinical knowledge to narrow down the likely causes, explain my thinking, and develop a plan that the patient understands and can buy in to. I am as interested in helping as they are in being helped, and they can feel it. I’m not in a rush and neither are they.
We follow up after the targeted testing we’ve performed and talk about any remaining symptoms. Some cases are more difficult and require a little more back and forth, but I can assure you that I am just as bothered by this puzzle as the patient is, and it’s rare that we can’t figure out the root cause.
Everyone who suffers from IBS symptoms should be on a search for the root cause.
It’s not enough to treat symptoms with a band-aid approach. If you have an understanding of the “why,” you will have the knowledge necessary to avoid symptoms in the future. Education is a key part of what I do in clinic - I want you to understand your body and why it is responding this way, so that you can intervene. Knowledge is power!
