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Medical and lay views of irritable bowel syndrome.

OBJECTIVES
The purpose of this study was to investigate doctors' and patients' views of irritable bowel syndrome (IBS) in order to assess why problems in the doctor-IBS patient relationship seem to occur.


METHODS
A qualitative study was undertaken involving in-depth, semi-structured interviews that were tape-recorded, transcribed verbatim and analysed using the constant comparative method. The subjects comprised 12 doctors, including six GPs and six gastroenterologists, and 14 patients with IBS.


RESULTS
Doctors hold two definitions of IBS, one 'public' and akin to a textbook definition, the other 'private' and including experiential knowledge and absorbed prejudices about IBS patients. Doctors are not universally hostile towards IBS patients, although the views of gastroenterologists may tend to be more pejorative than those of GPs. Most doctors experience frustration with IBS, and this is due as much to medical uncertainty and shortage of effective interventions as to intolerance of the personal characteristics of IBS patients. Doctors distinguish between 'good' and 'bad' IBS patients and manage them accordingly. Many patients tend to find their IBS symptoms very troublesome. Patients are more satisfied if they are taken seriously and helped to manage their symptoms, but many feel that they are labelled as neurotic by the medical profession. They tend to feel stigmatized and let down by doctors.


CONCLUSIONS
Better partnerships could be created with patients, and better outcomes for IBS might be achieved, if doctors recognized the impact of medical beliefs about IBS on patients. Doctors should offer IBS patients empowering explanations for their disorder.