How's That Working For You?

People are very unwilling to let go of their opinions. I see this most commonly when it comes to abdominal pain. I have many discussions with patients about abdominal pain. I do large workups for abdominal pain regularly. Many of the patients I see have already had extensive workups by gastroenterology— they’ve had blood tests, cameras shoved down their throats and up their butts—but no one has any answers. I have patients with ulcerative colitis whose GI specialists tell them that diet has nothing to do with their disease. It is baffling to me that this became the standard teaching for most of the GI doctors I’ve interacted with. How is it possible that things going wrong in your gut are not related to what you put in your gut? It seems like the most intuitive thing imaginable, yet we ignore it.

I guess our perspectives are very different. I see approximately 3,000 patients per year; that easily equates to 250–300 abdominal pain patients per year. Obviously, most patients have an N of 1. They have only their own experience, while I have experience talking to many more patients.

I was speaking with a 90-year-old patient the other day. She leaks stool regularly, which alternates with constipation. She has a diagnosis of IBS and has had the symptoms for 20 years. When I suggest that maybe she is not eating the right foods, her immediate defensive reaction is, “I eat healthy.”

From my perspective, clearly you do not. It is not normal to leak stool, have constipation, and suffer 20 years of abdominal pain. That is not a normal life. Your GI tract is not happy. With rare exceptions, the default assumption should be that something you are eating is the problem. Regardless of whatever you’ve been told is healthy, it is clearly not working for you.

In the ER I don’t have the opportunity to sit with patients for long, so I try to leave them with some knowledge that may be useful—which means they need to appreciate my opinion. They need to know that I genuinely care about their chronic medical issues so being snarky would not be helpful.

But I would very much like to ask them Dr. Phil’s question: “How’s that working for you?”