My doctor never listens to me. He tells me it’s just IBS. There is nothing seriously wrong and I must learn to live with it. The tablets he prescribes never work and I can never get to see a dietitian.
So why do doctors have such a bad press among you, the millions of people who suffer with IBS? Is it that they are just overworked and tired?. Do they not see IBS as a serious illness? Or could it be that you have expectations of our health service that it just can’t match?
Doctors can only do what they can within the time available. GPs in Britain have about eight minutes to see and examine every patient. Their priorities are not to miss anything life threatening, to make sure that they are meeting government incentives to best practice (QOF points) and to run a profitable and efficient practice. This is not what many anticipated when they applied to medical school.
Where is the sense of mission or dedication, the feeling of being able to make a difference to people’s lives? There is never enough time to do the detective work to establish a diagnosis; no opportunity to get to know their patients. What was once a detailed case history and a careful clinical examination have been replaced by tests, which reduce the patient to a figure on a form and never represent the illness in its personal context. Doctors have been trained in a medical model that is based less on building a trusting therapeutic relationship with their patients and more on the application of diagnostic criteria, management guidelines and evidence based treatments. GPs are apparatchiks, clerks that fill in forms and process people, directing them to the next cohort of specialist technicians. There is little time for understanding and compassion. This is not the fault of the doctor, most of whom yearn for the opportunity to practice proper medicine; it is the fault of an over-regulated state controlled health service.
Don’t misunderstand me. The NHS has saved millions of lives and made an enormous difference to the health and safety of people throughout Britain. As a nation state, we are justifiably proud of it, but somewhere among the gleaming concrete and glass hospital towers and state of the art health centres, the individual patient and their illness have got lost.
The new medical model may be an efficient system for conditions that have a definite pathology, can be diagnosed with specific diagnostic tests and have an effective treatment or treatment pathway. If I had a heart attack, I would want to be admitted to a District General Hospital without delay. The problem is that the vast majority of illness is not like that. Over 50% of the appointments in general practice and about the same number in hospital out-patients are for long term illnesses that doctors cannot diagnose or cure.
IBS has been described as a ‘functional’ or ‘medically unexplained’ condition. There is no specific pathology, no diagnostic test and no guaranteed cure or definitive treatment. The symptoms of IBS frequently overlap with those of other unexplained illnesses; fibromyalgia, chronic fatigue syndrome, backache, migraine. They are part of the same broad swathe of illness that would seem to be caused not by specific toxic or infective agent, but by the interaction of a range of factors in a persons environment; their diet and life style, life experience, their previous medical and drug history and the bacteria that occupy their colons. How can a health service that prides itself on accurate, specific diagnosis and prompt treatment cope with such a plethora of poorly explained holistic illness? The answer is that it doesn’t. How can an overworked GP devote the time needed to understand a condition like IBS, which is less the effect of a distinct pathological process and more the expression of an unwell person, when other patients in the waiting room may be at imminent risk of a stroke or a heart attack or suffering a kidney infection or an epileptic seizure? All they can do is to redirect their patients across the city to a hospital based gastroenterology service or down the corridor to the next overworked health professional, a dietitian or a counsellor maybe – GPs must be clapping their hands in relief that the dieticians seem so eager to seize the baton of IBS, but there are even fewer of them and waiting lists are always too long.
No wonder you are frustrated. And you are not alone. Millions of people suffer day in and day out with guts that tie themselves in knots or blow themselves up with gas and bowels that won’t behave. When my tooth hurts, all my attention is focused on my bad tooth and I want a dentist to see to it right now! So when your guts are in agony and you can’t tell when they are next going to let you down, the last thing you want is to be fobbed off with tablets that don’t work, referrals that waste time or ‘helpful’ comments like ‘it’s just IBS’, or ‘it’s stress, get over it!’ The fact of the matter is that despite the best intentions of its practitioners, the NHS or any health service throughout the ‘developed’ world cannot cope with the burden of IBS and other illnesses like it.
This is why Sue Backhouse and Christine Dancey created The IBS Network 25 years ago and why our volunteers and group leaders and the dedicated staff in our centre work so tirelessly to maintain and develop our mission. We do not necessarily claim that we have all the answers for IBS, but we can make a big difference. Information is power and our free IBS Self Care Plan already provides comprehensive information on all aspects of IBS; its nature, causative factors, diagnosis, and treatments. Our telephone helpline and email response service offers one to one contact with by IBS trained doctors, nurses and dieticians. Our network of self help groups aims to offer support for you in your locality.
This is a start. With your support, we can change things. We can train more health care professionals to help you understand and know how to manage your own IBS, we can conduct research on the questions you want to know about IBS and we can lobby government to devote more resource to enable health care professionals to offer people with IBS a much better deal than they currently receive. We can help you achieve a much better deal for IBS by all of these means and more, but we do need your support. So click on our website, www.theibsnetwork.org, become a member, donate anything you can afford, start a self help group in your locality, get involved, support our campaign and help us to make life for you a lot better.