I B S & The Art of Medicine

Is medicine a science, an art or both? 

When it comes to treating IBS there is no doubt that it is both.  And to be truly effective in healing patients with IBS,  the physician as artist  must assume a significant role.

Doctors like to believe that they are scientists and unquestionably they are  well versed in the scientific basis of bodily functions.  But when it comes to treating irritable bowel syndrome, scientists often don't do very well.  They continually seek the mathematic formula, the exact combination of diagnostic modalities and therapies which will guarrantee a successful outcome for their patients.  They are often terribly frustrated when such a paradigm does not appear, when their patients continue to suffer, when individuals don't respond to the evidence-based approach to treatment.

Because of the human element, individual variability precludes uncovering a simple treatment plan which works for every patient. When emotional and personality idiocyncracies are added to the mix, most "scientists" run for the  hills.

But physicians who treats IBS must be even more than artists.  They must be  psychologists,  therapists and clergymen. They must express interest, concern, empathy and compassion for their patients. They must acknowledge the real suffering which science still struggles to understand. But they must also offer hope.

They must offer themselves and their role as a healer as central to the process.  We can call this the placebo effect if we choose to do so.  I have no doubt that this plays a central role in the process.  But our primary goal is healing. Even if we don't understand exactly how and why this occurs. 

Although we cannot control what thoughts and feelings flood our neural circuits we can modify how our bodies react to them.  Meditation, exercise, diet, acupuncture, hypnosis, prayer, yoga, probiotics are "non drug" therapies seem to help some of us alleviate the suffering that accompanies such conditions as IBS. 

But I have had compelling success with prescribing certain anti-serotonin acting drugs which have helped to modify the neural responses to stress as well.  Most are known as anti-depressants.  But in many patients who are not overtly depressed these drugs are effective.

The challenge is to understand what each individual patient needs to alleviate their suffering. The open exchange involves understanding how the individual patient chooses to proceed with their therapy.  Are they more comfortable with nontraditional, "holistic" methods.  Do they prefer herbal and complementary therapies?  Do they just want a prescription for a drug and not care to be introspective or nontraditional.

 Each patient, each human being is unique. 

What is called for is the artist's approach to treating IBS.

2 thoughts on “I B S & The Art of Medicine”

  1. It is definitely both. The principles that you use to treat patients is based upon evidence-based science. The way you express those treatments, your logical reasoning behind those treatments, and further innovations in medicine are guided by art. Being able to empathise and communicate effectively with your patients is an art. You simply can’t treat your patients like biological water balloons.

  2. A look at one of the prevailing medical beliefs of people of the middle ages. The four humours, it was believed, had to be in perfect balance for a feeling of well-being, too much or not enough of any of the humours, and ill health followed.

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