Friday, September 30, 2005
Why do IBS patients have so many additional procedures that rarely help them?
"According to Spiegel, IBS patients often suffer from somatization. Since patients with somatization are sometimes perceived as 'complainers' by their doctors, the researchers hypothesized that physicians might respond to these complaints by ordering excessive tests instead of treating the somatization itself.
Researchers found that patients with high levels of somatization were not more likely to seek gastrointestinal care than those with low levels of the condition. Once evaluated for care by the doctors however, the patients with more severe somatization were significantly more likely to utilize more health care services.
'This finding suggests that the doctors and not the patients may be driving the need for procedures and surgeries that may not be necessary," said Dr. Brennan M.R. Spiegel, assistant professor of medicine, David Geffen School of Medicine at UCLA and VA Greater Los Angeles Healthcare System. 'We need to educate and train doctors to recognize somatization and treat this condition appropriately, rather than order a number of diagnostic tests as a reaction in the face of symptoms that are otherwise difficult to explain.'"
"According to Spiegel, IBS patients often suffer from somatization. Since patients with somatization are sometimes perceived as 'complainers' by their doctors, the researchers hypothesized that physicians might respond to these complaints by ordering excessive tests instead of treating the somatization itself.
Researchers found that patients with high levels of somatization were not more likely to seek gastrointestinal care than those with low levels of the condition. Once evaluated for care by the doctors however, the patients with more severe somatization were significantly more likely to utilize more health care services.
'This finding suggests that the doctors and not the patients may be driving the need for procedures and surgeries that may not be necessary," said Dr. Brennan M.R. Spiegel, assistant professor of medicine, David Geffen School of Medicine at UCLA and VA Greater Los Angeles Healthcare System. 'We need to educate and train doctors to recognize somatization and treat this condition appropriately, rather than order a number of diagnostic tests as a reaction in the face of symptoms that are otherwise difficult to explain.'"
Posted by Kevin |
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Comments:
Plaintiff lawyer: "Why didn't you order a 'whatchamacallitosis test' for this patient, if you had so, wouldn't he be alive and well today?"
# posted by 
: 1:21 PM
: 1:21 PM
I think that most of us in the frontline are aware that it's somatization. However, each one of us who have been in this business long enough are also aware of that ocassional patient who turn out to have Pancreatic CA, or Superior Mesenteric ischemia, Bowel Infarct,
Colon CA, intra-abdominal lymphoma, nephroma, intra-abdominal abscess and the list goes on. Sometimes, it's only through extensive workup that we know that this is a case of somatization. If we don't proceed this way with a 45 year old female with abdominal pain, we may doing our patients a disservice.
Colon CA, intra-abdominal lymphoma, nephroma, intra-abdominal abscess and the list goes on. Sometimes, it's only through extensive workup that we know that this is a case of somatization. If we don't proceed this way with a 45 year old female with abdominal pain, we may doing our patients a disservice.
# posted by : 2:29 PM
: 2:29 PM
This is an interesting, though somewhat controversial stand to take. When a patient presents with cramping and frequent diarrhea, there are other diagnoses to be excluded before arriving at IBS as a diagnosis. To rule out other etiologies such as IBD, celiac disease, cancer, etc., there are diagnostic studies that need to be performed. Does this therefore constitute an overuse of medical resources and too much testing? It seems necessary to consider other possibilities before making the assumption that IBS is in fact the correct diagnosis. There have been enough patients I know of now members of the CCFA who went years with the inccorrect diagnosis of IBS, when in fact the correct diagnosis was Crohn's disease.
The main problem with these people is the lack of continuity of care. Every time a depressed patient with fibromyalgia and IBS changes the practitioner, he will undergo some tests. Maybe when everybody will use EMR, some of the problems will be solved.
# posted by : 8:04 PM
: 8:04 PM
Yes, some of these patients (anecdotally, more so those on public medicaid) are going from ER to ER with extensive hospitalizations and work ups without even volunteering or admitting to the fact that they just had a work up at another facility. Since they aren't paying for it, the patient often doesn't own up to their own responsibility.
# posted by : 11:16 PM
: 11:16 PM
To anon 1216: think about it: if you're sick and the doctors run a bunch of tests and come back telling you there's nothing wrong with you, but you really ARE sick, wouldn't you go looking for another doctor, and start all over? If you tell the new doctor the last doctor told you it's all in your head, how seriously will the new doctor take you? Given the level of contempt SOME of the doctors posting here seem to hold their patients in, it's a necessary defensive mechanism in order to figure out why you're really sick.
Like Bad Shift's first post above -- "My doctor thought I was crazy, and now I have cancer!" Who is he mocking, and why? Having been the recipient of that same level of condescension and nearly dying from it, I can tell you it's no joke.
Just because your doctor says you're not sick doesn't mean you're not sick. So all you brilliant MDs who think the practice of medicine would be fine without the bother of patients, tell us all how to deal with that.
Like Bad Shift's first post above -- "My doctor thought I was crazy, and now I have cancer!" Who is he mocking, and why? Having been the recipient of that same level of condescension and nearly dying from it, I can tell you it's no joke.
Just because your doctor says you're not sick doesn't mean you're not sick. So all you brilliant MDs who think the practice of medicine would be fine without the bother of patients, tell us all how to deal with that.
# posted by : 11:19 AM
: 11:19 AM
This is a blog where most remain anonymous so every entry is not speaking to you or to your particular situation. All I really meant to say is that it would be nice to know what previous work up and tests have been done so the same resources are not used again and the work up can continue in another, perhaps enlightened, direction.
# posted by : 12:16 PM
: 12:16 PM
To Anon 1219: I think Bad Shift is mocking not the patients but the researchers who don't recommend "excessive testing". I can tell that he was not thrilled by these researchers' comments because of his previous comments on
his doing a lot of tests on his ER patients.(He had another bad day today at the ER.) My testing of these patients would be considered excessive as well by these researchers.
his doing a lot of tests on his ER patients.(He had another bad day today at the ER.) My testing of these patients would be considered excessive as well by these researchers.
# posted by : 12:52 PM
: 12:52 PM
I have IBS, and I seem to go from Doctor to Doctor, and hospital to hospital, cause nobody can ever tell me what's wrong with me. It's unfortunate that due to the risk of being sued, no doctor can tell me "it's in your head". I think I would feel alot better if someone would tell me that.
# posted by : 12:56 PM
: 12:56 PM
I have not read the original article in the American journal of Gastroenterology. I wonder if the researchers have come up with the SENSITIVITY and SPECIFICITY of the history and physical exam and pscychiatric history for a certain age group and gender to diagnose somatization as the etiology of persistent or recurrent abdominal pain. The only acceptable number is 100% sensitivity and 100% specificity. Any number less than 100% deviates from the standard of care. Would Dr. Spiegel be happy with somatization as the cause of his wife's abdominal pain based on History and Physical Exam? I doubt it. When it becomes a personal problem or if it involves family members, the statistics no longer count. I would not want my daughter's persistent abdominal pain be dismissed as somatization based on H and P alone.
# posted by : 1:13 PM
: 1:13 PM
Once there is an accurate biological marker for the diagnosis of IBS just as we have for CHF or Acute MI, then maybe I'll follow the researcher's advise.
# posted by : 1:44 PM
: 1:44 PM
I have IBS, and I seem to go from Doctor to Doctor, and hospital to hospital, cause nobody can ever tell me what's wrong with me.
I thought you said it was IBS?
I thought you said it was IBS?
# posted by : 8:50 PM
: 8:50 PM
"Given the level of contempt SOME of the doctors posting here seem to hold their patients in"
Not unlike the comptempt that SOME non-physicians have for doctors whom they haven't even met, eh Anon 12:19?
Not unlike the comptempt that SOME non-physicians have for doctors whom they haven't even met, eh Anon 12:19?
# posted by : 9:37 AM
: 9:37 AM
"Given the level of contempt SOME of the doctors posting here seem to hold their patients in"
Wanna know why? Subtract "patients", add in "prospective future litigants". Who needs this crap? Thanks alot sharks.
Wanna know why? Subtract "patients", add in "prospective future litigants". Who needs this crap? Thanks alot sharks.
# posted by : 10:48 AM
: 10:48 AM
IBS is a diagnosis of exclusion. Until it stops being a diagnosis of exclusion you are left having to check for diseases other than IBS such as adult onset celiac disease, non-classical inflammatory bowel disease, etc... It has nothing to do with malpractice. It is simply the correct progression to exclude other disease which can present similarly. You don't like it? Research a way to diagnose IBS with 98% sensitivity and 98% specificity.
# posted by : 1:18 AM
: 1:18 AM
You also didn't mention the reason that some people go from Doctor to Doctor is because some of us do have to pay for the multiple and expensive tests that are run. The last set of tests that I had, I was only making about $8 an hour and that doesn't cover a lot after other bills are paid. Besides would you really go back to a doctor that you can tell by what they say and the way they act, believes you’re a hypochondriac? They know that they can just keep on giving you different
tests until you run out of money and then you have to stop. I wish they could go through
just one month of what an IBS sufferer go through, and then that would change their attitude.
tests until you run out of money and then you have to stop. I wish they could go through
just one month of what an IBS sufferer go through, and then that would change their attitude.
# posted by : 2:15 PM
: 2:15 PM
>>>Subtract "patients", add in "prospective future litigants".<<<
Oh, spare me! This sorry excuse for negligence is getting very old. More importantly, facts prove otherwise.
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Oh, spare me! This sorry excuse for negligence is getting very old. More importantly, facts prove otherwise.
# posted by : 9:43 AM
: 9:43 AM
