Gastroenterology

Are we actually providing a MDT approach to our IBD patients?




  1. Jessica Anne Eccles1,2,
  2. Anna Ascott3,
  3. Rona McGeer4,5,
  4. Emma Hills6,
  5. Anja St.Clair Jones6,
  6. Lisa A Page7,
  7. Melissa A Smith6,
  8. Alana Loewenberger8,
  9. Jemima Gregory7

 

 

On so many occasions throughout my career I’ve reviewed a patient with inflammatory bowel disease where no matter what next “mab” I throw at them, no matter how much of their bowel is healed, there remains this void that no medical or surgical intervention can fill….I imagine for patients this must be exhausting. This poor doctor is trying their best to get me right, my bloods are normal, my endoscopy is the best it has been in years and yet I just don’t feel right….whats wrong with me?

 

The answer to anyone with a chronic disease or to anyone who looks after a patient with one is that it’s probably wrong to think that there is something wrong with you, and important to realise that it’s a perfectly normal phenomenon for a chronic disease to cause havoc with the person and psyche that makes you……. you.

 

That’s where often as IBD clinicans it’s easy to feel quite frustrated…what more can I offer this patient? What more can I do? The answer I think is to take a step back, realise that this patient in front of you requires in addition to your help, a unique set of skills, that have been developed over time that can help overcome some of the psychologic trauma that the disease has caused on their lives.

 

This article is an example and timely reminder to me that it is not necessarily my failure if I cannot fully  fix an IBD patient- I may be wrong but  for some patients, I suspect having IBD may be like facing a constant army that could attack at any minute, your defences are constantly primed for a potential sneak attack. Sometimes you have your doctor who is leading you into battle but without the game plan conjured up by the help of your clear mind, the battle can easily be lost.

 

Its articles like this that empower me as a doctor to try and do more outside my own expertise to help my patients. It’s a reminder that problems associated with IBD can often be invisible to the naked eye but if you examine the patient with the correct lens, you see a patient who needs a different type of help from the one you are so good at providing. It’s at times like these you put down the stethoscope, hold of that next endoscopy and call a friend to help you tackle this from a different angle.

To me this study highlighted the power of an integrated psychological therapy support for our IBD patients. In this study they secured funding to provide integrated psychological support for 75 patients with IBD between 2015 and 2017. What was absolutely no surprise to me ( and I’m sure anyone who looks after patients with IBD), was that the psychological intervention led to reductions in IBD symptoms (ΔSIBD; p=0.003), alongside improvements in depression scores (ΔPHQ-9, p=0.006) and global impression (ΔCGI; p=0.046).

 

We use a lot of buzz words in medicine the “ multi-disciplinary team” being one of my favourite words….it’s so often used in IBD care but to me if we continue to ignore and not provide psychological support are we really providing patients with “multi-disciplinary care?” There is a severe shortage of psychological support for not only IBD but for many chronic diseases. From an economic perspective, funding psychological services for IBD to me is a “no-brainer”. If you can reduce even one or two patients symptoms enough to avoid escalation in often expensive biological therapies you have saved your trust a fortune. Beyond this however, is a moral obligation….if patients with IBD benefit from psychological support surely as a nation we have to provide it? I know anecdotally this comes up as a vital gap in IBD services. I hope articles like this may influence policy makers to value psychological services so I can truly accept that I provide my patients with multi-disciplinary care.

 

Please visit the whole article here:

https://fg.bmj.com/content/early/2020/04/03/flgastro-2019-101323

The post Are we actually providing a MDT approach to our IBD patients? appeared first on Frontline Gastroenterology Blog.

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