Physiciansʼ Attitudes and Practices in the Evaluation and Treatment of Irritable Bowel Syndrome

Purpose: Despite the high prevalence of IBS, and the significant costs associated with it, little is known about how physicians perceive IBS. This study was designed to measure physicians' understanding of IBS, assess physicians' attitudes towards patients with IBS, and determine whether differences exist in the way Family Practice (FP), Internal Medicine (IM), and Gastroenterology (GI) physicians evaluate and treat IBS patients. Methods: A survey was sent to 3,000 physicians nationwide, 1,000 to each of 3 groups (FP, IM, and GI). The survey contained 35 questions assessing demographics, the etiology and pathophysiology of IBS, the use of diagnostic tests, and practice patterns and attitudes. Results: Of 3,000 questionnaires mailed, 501 questionnaires were completed (22.2% response rate); 472 saw only adult patients and these results were analyzed. The mean age of all respondents was 47; most were men (80%). IMs and FPs made a new diagnosis of IBS 1.3-1.6 times each week, while GIs made a new diagnosis 5.4 times each week (p <.0001). Compared to FPs and IMs, GIs felt that IBS patients were less sick than other patients (p <.001), although they required more time per visit. More GIs than FPs and IMs stated that a prior infection and a history of abuse caused IBS (p <.01); while FPs were more likely to believe that diet was a cause of IBS (p <.01). All 3 groups believed that IBS patients saw doctors more frequently than other patients, while GI felt that these patients required longer visits than other patients (p = 0.03). FPs and IMs were more likely to refer diarrhea-predominant IBS compared to other sub-types. Conclusions: The attitudes and practice patterns of physicians towards IBS patients differs based on practice specialty. This may occur due to differences in training, the ability to perform specialized tests, and/or differences in referral patterns. Further educational efforts may improve the ability of physicians in all specialties to confidently diagnose and treat patients with IBS.