Patients Can Have Feelings of Loss When IBD Improves

Patients will often improve. Yes, really, it does happen! It is interesting that getting better can be a type of loss. The patient improves, then loses their routine, and the physician loses a patient with which he was having regular followup. I relate an episode of arecent loss such as this.

The following is a post that was in the IBDList. Tom, the list moderator, added the comment at the end set off by brackets. The IBDList is a very valuable Maillist server for people interested in Crohn’s and colitis.If you like the sort of stuff you see here you would like to get the IBDList.

I had an interesting emotional response recently with a patient who was put into remission by surgery. This woman had her first attack of Crohn’s about a year ago. She did well with steroids, almost came off prednisone after a slow taper, then went back on with a flare. On attempting to re-taper she had another flare that turned into abscess. Surgery was required. TheCrohn’s diseased tissue was very thickened, and perhaps it would never have healed with medical treatment.

I had seen her about once ever month or every other month during this time and I got to know her well. When she came in for the post op check-up she was off all her medications and doing very well, eating anything she wanted, all the visible steroid effects gone. While I should have been happy that she would not have to see me anymore, I found myself somewhat sad. It was feeling the feeling of loss.

Clearly what was happening was that the patient and I had been having success at dealing with the Crohn’s, and much of the satisfaction for me was the continued followup and advice that kept her going and the improvement she had following my advice. Knowing that I would not have to do that any longer was, I think, the basis for this. I think another aspect was that she came to surgery without my having given the advice. Having a patient go sour is disconcerting to the physician (certainly more so to the patient),but there is something of a feeling of “how dare that Crohn’s disease get worse just as I was dealing with it.” Part of GI training is to have the knowledge that surgery is not an evil to be avoided, but rather a tool to be used as needed.

I recall a post Tom put up on the IBDList a while back about having a feeling of loss when in remission from IBD. The loss was in not doing the dietary restrictions and other things that had become routine, or familiar, to daily life.

Oh, the reason I put this up is that this is a list about IBD, living with it, and treatment of it. While I don’t think there is anything in this post that will affect what anybody does, it is the case that IBD affects many people besides the patient, and the physician is one of them.

Stephen Holland, M.D.

[ Thanks for an interesting perspective. I know that when a GI I had been seeing for a number of years retired, I missed him as a person as much as missing the physician. I never considered that he also might have feelings of the loss of day-to-day contact with his set of patients.

Diabetics these days often have a team of professionals helping them with their disease since it affects so many areas of physical, emotional and spiritual life. In a way it is too bad that the medical community often doesn’t take a more all-encompassing approach to diseases such as IBD that are influenced by more than just the steroids or sulfa drugs. Maybe one day the insurance companies will realize that a combination of treatments, along with a healthy look at eastern or alternative medications and procedure scan actually be cheaper than the most common methods of symptom-treatmen tor emergency-care medicine. -tom]