The New York Times features a regular column entitled “Think Like a Doctor” written by Lisa Sanders, MD. In it, the details of actual interesting or perplexing medical cases, with the patients’ identifying information removed, are presented in the online version of the newspaper. Readers, both medical professionals and laypeople, are then challenged to comment with their guesses of the correct diagnoses. The answers, plus commentary from Dr. Sanders and her sources, are eventually discussed in a followup column published online, and within a few days, in print.
On September 5, 2013, Dr. Sanders first offered the situation of a teenaged girl who was a competitive gymnast and who had been experiencing chronic gastrointestinal difficulties. On September 6, in “Think Like a Doctor: The Gymnast’s Big Belly Solved,” Dr. Sanders revealed that ultimately, the young woman was diagnosed with a combination of two functional gastrointestinal disorders, and had begun treatment, which appeared to have been helpful. The print version of this article appeared in the Times’ Sunday magazine section on September 8.
In some respects, it is pleasing to see functional gastrointestinal disorders as the topic of an article in The New York Times, which is a major mainstream news source with an enduring reach nationally and internationally, far beyond New York City where it is published. The column correctly notes that functional gastrointestinal disorders collectively affect about 25% of the population and are involved in about 40% of GI-related visits to doctors, and that irritable bowel syndrome is one of the best known functional gastrointestinal disorders. There is some explanation of what a functional gastrointestinal disorder is. There is also a brief reference made to the Rome criteria, the current international standard by which functional gastrointestinal experts believe such disorders can be diagnosed with a high degree of accuracy. Also, Dr. Sanders acknowledges that, in general, functional gastrointestinal disorders are being regarded by the medical profession with more legitimacy than in the past. Discussion of reputable information on functional gastrointestinal disorders by such a high profile media source, would seem to be good for public awareness.
On the other hand, the young patient’s experiences on the path to correct diagnosis and treatment, as described by Dr. Sanders, as well as some of the posted comments from readers, also highlight common and continuing stereotypes among health professionals and the general public alike. In a blog post entitled, “Misunderstood Functional GI Disorders: Gymnast’s Case Shows Why We Must Accept FGIDs as a Chronic Disorder,” which he posted on September 17, 2013, Douglas Drossman, MD, FACG responds to the Times column. Dr. Drossman, who is the founder of Drossman Gastroenterology and the Drossman Center for the Education and Practice of Biopsychosocial Care, the founder and president of the Rome Foundation, and the founder and co-director emeritus of the University of North Carolina Center Functional GI and Motility Disorders, is one of the leading international authorities in functional gastrointestinal disorders. He has held numerous additional roles in the development of the field over four decades of his career as a clinician, researcher and academic.
Dr. Drossman outlines a few major concerns about the piece. Firstly, the gymnast is described as having seen numerous health care professionals in various specialties and undergone many tests and unsuccessful conventional and complementary treatments over a long course of debilitating symptoms. This is not an uncommon experience for people with functional gastrointestinal disorders, implying that they are rare or difficult diagnoses that need to be made by ruling out an extensive list of other potential disorders. This is counter to the symptom-based approach, involving limited tests in some specific situations, that experts like Dr. Drossman have long advocated. Secondly, when the majority of the young woman’s test results showed nothing obvious, some health care professionals she encountered wrongly concluded that the problem was “in her head” rather than the two neurogastroenterological disorders it is. Thirdly, Dr. Drossman judges the published resolution of the patient’s diagnosis and treatment as a bit too much “poetic license,” implying a relatively quick cure. He cautions his readers to remember that while there are diagnoses and some treatments available, for the vast majority of us dealing with one or more functional gastrointestinal disorders, these are chronic conditions that must be managed on a recurring or constant basis. He expresses concern that the Times column may have the unintended effect of motivating readers to seek more unneeded tests that are usually un-revealing in functional gastrointestinal disorders, in the hope of as positive an outcome as portrayed for the young gymnast.
IBS Impact concurs with Dr. Drossman that these aspects of the column are problematic. Some iteration of the Rome criteria has been in existence for over two decades, making diagnosis by exclusion outdated. The assumption that we are all imagining our medical condition, or are causing it by psychological problems we may or may not actually have is a familiar frustration of many of us with IBS or other functional gastrointestinal disorders, who often have difficulty getting some supposedly well-experienced professionals to take our very real physical concerns seriously, just because functional gastrointestinal disorders are sometimes associated with or exacerbated by stress or other mental health diagnoses. The actual biopsychosocial interactions involved in IBS and related disorders are more complex, as noted in Dr. Drossman’s source links in his post. Finally, while the temptation for those of us with moderate to severe and/or constant symptoms to chase after anything or anyone with the remotest possibility of help at any cost is very real and very understandable, over years of disappointments, that proves neither realistic nor pragmatically and financially sustainable for many of us. Our hope for the future may become directed in different ways, such as the awareness and self-advocacy that IBS Impact encourages.
It’s impossible to know for sure the effects of the Times article on any given reader. It is hoped that, on balance, the positive aspects of the piece open eyes to functional gastrointestinal disorders more often than the negative aspects influence public perception. This post highlighting the article and Dr. Drossman’s response attempts to continue the conversation on functional gastrointestinal disorders in a public way, so that voices of affected people and professionals who have lived with or among FGIDs every day for months or years. can be directly heard, not merely filtered through a newspaper’s interpretation. We encourage readers and fellow bloggers to share their reactions.