How does patient reluctance to discuss symptoms create an obstacle to diagnosis and treatment?

Lin Chang MD  

I think patients' reluctance to share their symptoms and their experience can really be an obstacle for patient management, both for diagnosis and treatment. Having chronic or recurrent GI symptoms of IBS can be very embarrassing to patients. In general, the public doesn't feel comfortable talking about bowel habits. They don't want to share that information with other people, including their friends or family.

For example, if they have diarrhea, even fecal incontinence, it can be very embarrassing for them. Guilt and shame are involved. They may not be able to work or go to school as well as they could if they didn't have their symptoms. So they're really reluctant to share that.

I think also that, with IBS patients, the fact that their tests are normal makes them believe it may be all in their head. So sometimes, they don't want to share that information. Besides, a lot of patients may actually not feel that there are effective treatments, so they say, "Why bother telling my physician?"

But the physician can do several things to make the patient-physician relationship easier, to have the patient open up about their symptoms. Physicians can engage in active listening, let the patient do more of the talking. They can show verbal and nonverbal cues validating the patients' symptoms, giving them hope. And they can educate them about IBS. They can let them know that many people have this disorder and can offer information about the different treatments that are available.