General Practitioners and Hospital Specialists Have Different Perceptions of Irritable Bowel Syndrome
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General practitioners' perceptions of chronic fatigue syndrome and beliefs about its management, compared with irritable bowel syndrome: qualitative study
General Practitioners and Hospital Specialists Have Different Perceptions of Irritable Bowel Syndrome
Editor –The study by Raine et al provides us with a rare insight in
to general practitioners’ (GPs) perceptions concerning chronic fatigue
syndrome and irritable bowel syndrome (IBS) and the implications that
these opinions have on treatment preferences [1].
We collected similar data regarding IBS from GPs, but additionally
compared this with opinions from hospital specialists (HS)[2]. Using a
questionnaire employing a scoring system of 1 (strongly disagree) to 5
(strongly agree) we found that both groups of doctors had similar
perceptions about patients levels of neuroticism (HS3,GP2.6), anxiety
(HS3.8,GP3.6) and hysteria (HS2.1,GP1.9) although the specialists felt
that patients were more depressed (HS3.4,GP2.8)* and demanding
(HS3.1,GP2.4)* than GPs. In addition each physician group was asked to
place the following possible pathophysiological mechanisms in order of
decreasing importance. Specialists thought that hypersensitivity* was of
paramount importance, followed by motility, stress, infection, and then
diet*. GPs ranked stress as most important, followed by motility,
hypersensitivity, diet and finally infection. (* Indicates a statistically
significant difference between groups). Regarding treatment: GPs were
significantly more likely to use dietary measures and antispasmodics where
-as consultants were less likely to use laxatives. There were no
significant differences in the use of antidiarrhoeals, or somewhat
surprisingly, antidepressants.
Despite the prevalence of IBS, relatively little is known about
doctors’ perceptions of the illness. In the future, advances in basic
science and clinical research may not only result in better treatments
being developed, but should also advance our understanding of the
underlying pathophysiology. Hopefully this will result in legitimisation
of the illness and a reduction in some of the preconceptions and
misconceptions that surround this condition.
References
[1] Raine R, Carter S, Sensky T, Black N. General practitioners'
perceptions of chronic fatigue syndrome and beliefs about its management,
compared with irritable bowel syndrome: qualitative study. BMJ,
doi:10.1136/BMJ 38078.503819.EE (published 28th May 2004)
[2] Lea R, Houghton LA, Hasleton J, Whorwell PJ. Different approaches
to the management and understanding of pathophysiology of irritable bowel
syndrome (IBS) in primary and secondary care. Gut 2002; 51: A248
[3] Lea R, Houghton LA, Hasleton J, Whorwell PJ. Diagnostic Criteria
for Irritable Bowel Syndrome: Utility and Applicability in Clinical
Practice. Digestion 2004. In press.
Rapid Response:
General Practitioners and Hospital Specialists Have Different Perceptions of Irritable Bowel Syndrome
Editor –The study by Raine et al provides us with a rare insight in
to general practitioners’ (GPs) perceptions concerning chronic fatigue
syndrome and irritable bowel syndrome (IBS) and the implications that
these opinions have on treatment preferences [1].
We collected similar data regarding IBS from GPs, but additionally
compared this with opinions from hospital specialists (HS)[2]. Using a
questionnaire employing a scoring system of 1 (strongly disagree) to 5
(strongly agree) we found that both groups of doctors had similar
perceptions about patients levels of neuroticism (HS3,GP2.6), anxiety
(HS3.8,GP3.6) and hysteria (HS2.1,GP1.9) although the specialists felt
that patients were more depressed (HS3.4,GP2.8)* and demanding
(HS3.1,GP2.4)* than GPs. In addition each physician group was asked to
place the following possible pathophysiological mechanisms in order of
decreasing importance. Specialists thought that hypersensitivity* was of
paramount importance, followed by motility, stress, infection, and then
diet*. GPs ranked stress as most important, followed by motility,
hypersensitivity, diet and finally infection. (* Indicates a statistically
significant difference between groups). Regarding treatment: GPs were
significantly more likely to use dietary measures and antispasmodics where
-as consultants were less likely to use laxatives. There were no
significant differences in the use of antidiarrhoeals, or somewhat
surprisingly, antidepressants.
Despite the prevalence of IBS, relatively little is known about
doctors’ perceptions of the illness. In the future, advances in basic
science and clinical research may not only result in better treatments
being developed, but should also advance our understanding of the
underlying pathophysiology. Hopefully this will result in legitimisation
of the illness and a reduction in some of the preconceptions and
misconceptions that surround this condition.
References
[1] Raine R, Carter S, Sensky T, Black N. General practitioners'
perceptions of chronic fatigue syndrome and beliefs about its management,
compared with irritable bowel syndrome: qualitative study. BMJ,
doi:10.1136/BMJ 38078.503819.EE (published 28th May 2004)
[2] Lea R, Houghton LA, Hasleton J, Whorwell PJ. Different approaches
to the management and understanding of pathophysiology of irritable bowel
syndrome (IBS) in primary and secondary care. Gut 2002; 51: A248
[3] Lea R, Houghton LA, Hasleton J, Whorwell PJ. Diagnostic Criteria
for Irritable Bowel Syndrome: Utility and Applicability in Clinical
Practice. Digestion 2004. In press.
Competing interests:
None declared
Competing interests: No competing interests