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Do We Know What Patients Want? The Doctor-Patient Communication Gap in Functional Gastrointestinal Disorders

https://doi.org/10.1016/j.cgh.2009.06.025Get rights and content

Background & Aims

Understanding patients' expectations at initial consultation for functional gastrointestinal disorders (FGIDs) might influence future health care utilization. Ideally, patients and doctors would have a common understanding of the issues involved. We sought to investigate this with matched questionnaires.

Methods

Patients' needs/expectations/understanding were compared with gastroenterologists' and general practitioners' awareness of these. Patients were followed up to investigate satisfaction with and outcomes of specialist consultation.

Results

Specialists underestimated the number and severity of patients' symptoms (in 43% and 41%, respectively), and patients and specialists had quite discordant views on what treatment would best suit their symptoms. Strikingly, only 1 of 13 patients available for follow-up agreed with or accepted the functional diagnosis, despite all being diagnosed by a specialist as having an FGID.

Conclusions

In FGIDs there is a communication gap between patients and gastroenterologists. Importantly, at follow-up, patients do not acknowledge their FGID diagnosis. This communication gap and lack of acceptance of a functional diagnosis are likely to influence future management and health care utilization.

Section snippets

Methods

All referrals to a general adult gastroenterology outpatient department at a metropolitan hospital were screened for 6 months. Where referrals indicated a likely FGID, subjects were invited by mail to participate before their specialist consultation. Subjects were not considered if their referral indicated need for an interpreter, confounding comorbidities, or major psychosocial issues. Each patient-gastroenterologist pair independently completed a questionnaire (Appendix 1). After consultation

Participants

Invitations were sent to 75 referred patients. Only 31 attended their specialist appointment. Two opted out, and 2 had missing data, leaving 27 participants with a clinical FGID diagnosis (22 women), mean age, 37.3 years (range, 20–74; median, 32 years), where both patient and gastroenterologist completed questionnaires at initial consultation. Referring GPs for 13 of 27 subjects participated. Mean time from initial encounter to attempted follow up was ∼20 weeks; only 13 of 27 patients were

Discussion

In this novel study in FGIDs, we directly and concurrently examined the perceived needs/expectations of patients and whether their specialists and referring GPs are aware of these patient perceptions. Two striking findings were the high level of miscommunication between patients and specialists and the unexpected fact that only 1 patient owned/acknowledged the FGID diagnosis at follow-up.

Concordance between patients and doctors was acceptable in objective information such as past diagnosis.

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Conflicts of interest The authors disclose no conflicts.

Funding Supported by Clinical Project Grant, Royal Adelaide Hospital/Hanson Institute, 2009.

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