Strategy to Improve the Doctor-Patient Relationship in IBD
Strategy to Improve the Doctor-Patient Relationship in IBD
The doctor–patient relationship (DPR) in inflammatory bowel disease (IBD) has been facing new challenges, in part due to the substantial progress in medical and surgical management and also due to the rapid expansion of patient access to medical information. Not surprisingly, the complexity of IBD care and heterogeneity of the disease types may lead to conflict between a physician's therapeutic recommendations and the patient's wishes. In this commentary, we propose that the so-called "treat-to-target" approach of objective targets of disease control and serial adjustments to therapies can also strengthen the DPR in IBD by enabling defined trials of alternative approaches, followed by a more objective assessment and reconsideration of treatments. We contend that such respect for patient autonomy and the use of objective markers of disease activity improves the DPR by fostering trust and both engaging and empowering patients and physicians with the information necessary to make shared decisions about therapies.
A positive doctor–patient relationship (DPR) is a necessary and fundamental feature of managing patients with inflammatory bowel disease (IBD). Although the primacy of the DPR is a core principle in the foundation of medical care, there are unique features of IBD that make this concept especially important. These features include the chronic nature of IBD, the social stigmatization that comes from having a bowel disease, and the fact that despite many advances, there remain large gaps in our understanding of the pathogenesis and a large proportion of patients without adequate disease control.
Given these limitations, one of the major challenges to managing IBD is the choice and subsequent communication of therapeutic recommendations. Ideally, such discussions need to include adequate communication of the disease severity and prognosis, followed by disclosure of all appropriate treatment options and the potential benefits and risks of such treatments. Respect for patient autonomy then allows the appropriately informed patient to choose or to refuse their treatment course. In the United States and other parts of the world, most interactions between the physician and the patient involve a shared decision-making approach, in which both parties readily exchange information about risks and benefits and together come to a mutually agreed upon plan for management (Figure 1).
(Enlarge Image)
Figure 1.
The traditional doctor–patient relationship in inflammatory bowel disease.
Abstract and Introduction
Abstract
The doctor–patient relationship (DPR) in inflammatory bowel disease (IBD) has been facing new challenges, in part due to the substantial progress in medical and surgical management and also due to the rapid expansion of patient access to medical information. Not surprisingly, the complexity of IBD care and heterogeneity of the disease types may lead to conflict between a physician's therapeutic recommendations and the patient's wishes. In this commentary, we propose that the so-called "treat-to-target" approach of objective targets of disease control and serial adjustments to therapies can also strengthen the DPR in IBD by enabling defined trials of alternative approaches, followed by a more objective assessment and reconsideration of treatments. We contend that such respect for patient autonomy and the use of objective markers of disease activity improves the DPR by fostering trust and both engaging and empowering patients and physicians with the information necessary to make shared decisions about therapies.
Introduction
A positive doctor–patient relationship (DPR) is a necessary and fundamental feature of managing patients with inflammatory bowel disease (IBD). Although the primacy of the DPR is a core principle in the foundation of medical care, there are unique features of IBD that make this concept especially important. These features include the chronic nature of IBD, the social stigmatization that comes from having a bowel disease, and the fact that despite many advances, there remain large gaps in our understanding of the pathogenesis and a large proportion of patients without adequate disease control.
Given these limitations, one of the major challenges to managing IBD is the choice and subsequent communication of therapeutic recommendations. Ideally, such discussions need to include adequate communication of the disease severity and prognosis, followed by disclosure of all appropriate treatment options and the potential benefits and risks of such treatments. Respect for patient autonomy then allows the appropriately informed patient to choose or to refuse their treatment course. In the United States and other parts of the world, most interactions between the physician and the patient involve a shared decision-making approach, in which both parties readily exchange information about risks and benefits and together come to a mutually agreed upon plan for management (Figure 1).
(Enlarge Image)
Figure 1.
The traditional doctor–patient relationship in inflammatory bowel disease.
