Feature

Q&A: Believing IBS is a disease of ‘nervous, anxious women’ is ‘antiquated’ and ‘wrong’

Mark Pimentel, MD
Mark Pimentel

Imagine being a physician specialized in a certain area and hearing that something being taught in a board review course for recertification could be classified as outdated or antiquated.

Now imagine that what was said in that review course singled out one sex and identified the disease derives from being a woman.

For Mark Pimentel, MD, executive director of the Medically Associated Science and Technology (MAST) Program at Cedars Sinai Medical Center, that imagination became reality.

Pimentel heard about an instance where during a video board review course, a doctor labeled irritable bowel syndrome as a “disease of nervous and anxious women.”

As a result, Pimentel went to Twitter to express his frustrations with that comment and received more than 40 comments, 60 retweets and almost 300 likes.

Healio Gastroenterology and Liver Disease spoke with Pimentel about his reaction to those comments, the problems associated with those beliefs, and how to try to better educate physicians. – by Ryan McDonald

Healio: How did you hear about this comment, and what was your reaction?

Pimentel: Someone I know had been prepping for their recertification and after watching the video for the recertification, pointed out to me that the doctor on the video expressed this language and I found it shocking. Some of the questions the doctor had created as mock questions for the exam were equally antiquated. I thought it was inappropriate to be teaching people who are getting ready for exams knowledge that hasn’t been the way we have thought about IBS for more than a decade.

Healio: How common do you think this belief is among physicians?

Pimentel: I have made it a mission of mine to try to educate clinicians out there. I can’t imagine being a primary care doctor in 2018, with how busy things are, reimbursements are down, and a lot of these doctors don’t have time for educational meetings like they used to. Physicians may be a decade out of training and they may not have gotten up-to-date on some of the new thinking in IBS.

They’re basically relying on what they were taught 20 years ago, which was that IBS is a psychological disease. I know this for a fact because when I have recently been in several primary care CME and educational sessions, and it’s as if their mind is open to what IBS is and they have no clue of all the new developments that have come out. For instance, postinfectious IBS and all these different facets that we now think cause IBS. They just haven’t heard it at all.

Now imagine a patient going to their doctor, in this case their primary doctor, and the doctor is still not up to date and saying things like, ‘well, it’s a psychological issue, you need to reduce stress.’ We know that that’s not the ideal treatment for IBS; they just are undereducated.

Healio: What are the concerns with this ‘antiquated’ belief?

Pimentel: There’s several concerns. Patients feel dismissed and underappreciated by their physician. They feel that they have a real problem and their clinician is essentially saying, ‘Ah, it’s nothing. Don’t worry about it, go home and get back to work.’ It’s not quite that simple. Or, they’re labelled with a psychological condition which could be detrimental because if a physician puts that in the chart and it’s not correct, it can have implications in terms of disability insurance and other things. So, it’s not good practice for 2018.

The other side of this is the possibility of doctors just ordering a series of invasive tests that the patient may or may not need. This is something that I have been fighting against: the cost of IBS to the patient through the health care system is too high because of all the unnecessary colonoscopy, CT scans and ultrasounds. If a clinician was well versed in the disease, they would not have needed all those tests because it would have been more obvious to them that the patient had IBS and what the implications and treatments were.

Healio: How do you think the field overcomes these beliefs?

Pimentel: There was one other aspect of that doctor’s statement that was probably the most insulting, which was the term woman. While IBS is more common in women, it isn’t that much more common. It’s not five times or 10 times more common in women, but rather less than two times more common in women. So, to suggest IBS is a neurotic female disease is also very gender derogatory because the person did not say that it’s an anxious or neurotic disease, they said it’s anxious and neurotic women. That’s the second piece of that which was very gender biased.

Healio: Do you think new approaches need to be implemented to combat this?

Pimentel: This is a very difficult problem to solve. Reimbursement is down, doctors can’t take time out of their practices to go to educational practices like they used to, and to be honest, IBS has been sort of a boring disease. For years, it was thought, ‘well, we don’t know what’s going on, it’s psychological’ and there were lectures on IBS that were not insightful and uninspired because we didn’t know. When physicians hear about an IBS lecture they think, ‘I’ll go to the cardiology lecture instead,’ because they anticipate there is nothing new in IBS. You must not only educate them about IBS, but we also need to increase the excitement around IBS so that clinicians are interested in listening. There really is a lot new here that is eye-opening and revolutionary.

Healio: As a practicing gastroenterologist, how do you handle patients when they come in from a referral from a physician who might have the mindsight that IBS is a psychological disease?

Pimentel: So often when these patients come in, they come in with very low expectations because they anticipate that I’m going to say the same thing or that I will dismiss them. Of course, I don’t and that itself is refreshing to the patient, just the fact that I am not dismissive and judgmental. These doctors are making a judgement before they even see the patient. But, these patients feel insulted. I have heard that many times. They feel insulted by their previous clinicians in the way that they were treated, and you can see that from the comments on my Twitter feed and the responses from other people. I think it is interesting to see and study the responses and what these patients are experiencing real-time on Twitter.

Healio: What led you to tweet about this doctor’s comments?

Pimentel: I don’t use Twitter because I’m trying to gain followers or I’m trying to do this for any business purpose, but rather I’m doing it for empowerment and education. I’m trying to get the word out there that there’s new evidence out there. When there’s an exciting development, I try to announce it in however many ways I can.

The problem is when it’s published in a scientific journal, patients don’t know about it. It’s not very well publicized for the lay public and so I use some of these social media platforms to send off the information, dissect it and provide something that will be beneficial to the patient and any clinicians that are following on these platforms.

Disclosures: Pimentel reports no relevant disclosures.

Mark Pimentel, MD
Mark Pimentel

Imagine being a physician specialized in a certain area and hearing that something being taught in a board review course for recertification could be classified as outdated or antiquated.

Now imagine that what was said in that review course singled out one sex and identified the disease derives from being a woman.

For Mark Pimentel, MD, executive director of the Medically Associated Science and Technology (MAST) Program at Cedars Sinai Medical Center, that imagination became reality.

Pimentel heard about an instance where during a video board review course, a doctor labeled irritable bowel syndrome as a “disease of nervous and anxious women.”

As a result, Pimentel went to Twitter to express his frustrations with that comment and received more than 40 comments, 60 retweets and almost 300 likes.

Healio Gastroenterology and Liver Disease spoke with Pimentel about his reaction to those comments, the problems associated with those beliefs, and how to try to better educate physicians. – by Ryan McDonald

Healio: How did you hear about this comment, and what was your reaction?

Pimentel: Someone I know had been prepping for their recertification and after watching the video for the recertification, pointed out to me that the doctor on the video expressed this language and I found it shocking. Some of the questions the doctor had created as mock questions for the exam were equally antiquated. I thought it was inappropriate to be teaching people who are getting ready for exams knowledge that hasn’t been the way we have thought about IBS for more than a decade.

Healio: How common do you think this belief is among physicians?

Pimentel: I have made it a mission of mine to try to educate clinicians out there. I can’t imagine being a primary care doctor in 2018, with how busy things are, reimbursements are down, and a lot of these doctors don’t have time for educational meetings like they used to. Physicians may be a decade out of training and they may not have gotten up-to-date on some of the new thinking in IBS.

They’re basically relying on what they were taught 20 years ago, which was that IBS is a psychological disease. I know this for a fact because when I have recently been in several primary care CME and educational sessions, and it’s as if their mind is open to what IBS is and they have no clue of all the new developments that have come out. For instance, postinfectious IBS and all these different facets that we now think cause IBS. They just haven’t heard it at all.

Now imagine a patient going to their doctor, in this case their primary doctor, and the doctor is still not up to date and saying things like, ‘well, it’s a psychological issue, you need to reduce stress.’ We know that that’s not the ideal treatment for IBS; they just are undereducated.

PAGE BREAK

Healio: What are the concerns with this ‘antiquated’ belief?

Pimentel: There’s several concerns. Patients feel dismissed and underappreciated by their physician. They feel that they have a real problem and their clinician is essentially saying, ‘Ah, it’s nothing. Don’t worry about it, go home and get back to work.’ It’s not quite that simple. Or, they’re labelled with a psychological condition which could be detrimental because if a physician puts that in the chart and it’s not correct, it can have implications in terms of disability insurance and other things. So, it’s not good practice for 2018.

The other side of this is the possibility of doctors just ordering a series of invasive tests that the patient may or may not need. This is something that I have been fighting against: the cost of IBS to the patient through the health care system is too high because of all the unnecessary colonoscopy, CT scans and ultrasounds. If a clinician was well versed in the disease, they would not have needed all those tests because it would have been more obvious to them that the patient had IBS and what the implications and treatments were.

Healio: How do you think the field overcomes these beliefs?

Pimentel: There was one other aspect of that doctor’s statement that was probably the most insulting, which was the term woman. While IBS is more common in women, it isn’t that much more common. It’s not five times or 10 times more common in women, but rather less than two times more common in women. So, to suggest IBS is a neurotic female disease is also very gender derogatory because the person did not say that it’s an anxious or neurotic disease, they said it’s anxious and neurotic women. That’s the second piece of that which was very gender biased.

Healio: Do you think new approaches need to be implemented to combat this?

Pimentel: This is a very difficult problem to solve. Reimbursement is down, doctors can’t take time out of their practices to go to educational practices like they used to, and to be honest, IBS has been sort of a boring disease. For years, it was thought, ‘well, we don’t know what’s going on, it’s psychological’ and there were lectures on IBS that were not insightful and uninspired because we didn’t know. When physicians hear about an IBS lecture they think, ‘I’ll go to the cardiology lecture instead,’ because they anticipate there is nothing new in IBS. You must not only educate them about IBS, but we also need to increase the excitement around IBS so that clinicians are interested in listening. There really is a lot new here that is eye-opening and revolutionary.

PAGE BREAK

Healio: As a practicing gastroenterologist, how do you handle patients when they come in from a referral from a physician who might have the mindsight that IBS is a psychological disease?

Pimentel: So often when these patients come in, they come in with very low expectations because they anticipate that I’m going to say the same thing or that I will dismiss them. Of course, I don’t and that itself is refreshing to the patient, just the fact that I am not dismissive and judgmental. These doctors are making a judgement before they even see the patient. But, these patients feel insulted. I have heard that many times. They feel insulted by their previous clinicians in the way that they were treated, and you can see that from the comments on my Twitter feed and the responses from other people. I think it is interesting to see and study the responses and what these patients are experiencing real-time on Twitter.

Healio: What led you to tweet about this doctor’s comments?

Pimentel: I don’t use Twitter because I’m trying to gain followers or I’m trying to do this for any business purpose, but rather I’m doing it for empowerment and education. I’m trying to get the word out there that there’s new evidence out there. When there’s an exciting development, I try to announce it in however many ways I can.

The problem is when it’s published in a scientific journal, patients don’t know about it. It’s not very well publicized for the lay public and so I use some of these social media platforms to send off the information, dissect it and provide something that will be beneficial to the patient and any clinicians that are following on these platforms.

Disclosures: Pimentel reports no relevant disclosures.