Sunday, November 7, 2021

How to Treat Your Upset Stomach

There is a general fascination with the medical profession.  Consider how many television shows over past decades have had a medical motif.  And today’s patients are so ├╝ber-informed and empowered, that at times they dabble with the practice of medicine themselves as an avocation.  When a patient, for example queries me about Barrett’s esophagus and dysplasia or if I intend to test them for H. pylori, a germ that resides in the stomach, then I know by their use of medical terminology that the office visit will be a  "peer to peer” experience.

So, I’ll ask my erudite reader-practitioners to respond to the following medical inquiry. 

A patient is suffering from a chronic upset stomach (called dyspepsia) nearly every day.  The cause of the condition cannot be ascertained, and the treatment options are wanting.  Assume that the medical professional has undertaken an appropriate evaluation and that no cause has been discovered.  Assume as well that there is no established treatment for the condition. Nevertheless, it is commonplace for doctors to offer various prescriptions to these patients.


The stomach often hurts for mysterious reasons.

If you were the doctor, which of the following would you advise?

Tell the patient that there is no effective treatment for his condition and that he will need to continue to live with it as best he can.

Tell the patient that, while there is no proven remedy, that there are various medicines to consider that the he has prescribed to others.  You recommend one of them.

My guess is that most readers and patients would prefer option #2 for reasons that need not be explained.  Most doctors and patients would rather do something than nothing.

As medical professionals know, and often lament, there are too many drugs being prescribed.  We know this and yet we physicians are the perpetrators.  And, the public has an outsized appetite for pharmaceuticals.  This has proved to be an unshakable cycle to break. 

What could be wrong about offering a prescription to a patient with unexplained dyspepsia? 

  • Physicians and patients should be guided by science and truth.
  • It is not fair to expend resources on ineffective medicines
  • It is not ethical to expose patients to risks of adverse reactions without any reasonable promise of benefit.
  • Physicians should not serve as willing accomplices in the over-medication of our society.
  • The medical profession and the public should come to terms that not every medical symptom has a pharmaceutical remedy.

So, what could be done for these patients?  There is a rising role for integrative medicine and other alternative medical practices for patients with unexplained and unexplainable medical symptoms.  And, if a conventional doctor like me starts carping that those alternative folks operate without data or proof, then point out that  we medical doctors have been doing this forever.

 

 

 

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