Drossman Gastroenterology welcomed Rome Visiting Scholars Dr. Baharak Moshiree, Dr. Elyse Thakur and MacKenzie Jarvic PA-C to the office August 27-29, 2019 from Atrium Health in Charlotte, NC. They also met with Rome Board Members Dr. Olafur Palsson and Dr. William Whitehead at the UNC Center for Functional GI and Motility disorders to discuss research.
Dr. Baharak Moshiree (BM), Dr. Elyse Thakur (ET), and MacKenzie Jarvis (MJ)
ET: “…this week was truly fantastic. We have all gained so much through the Rome Clinical Scholars program. I really appreciate you hosting us. The two days in clinic were incredibly valuable — it was impressive to see how well you connected with patients, and I greatly benefited from watching you educate patients about the brain-gut connection and your approach to GI care. I’ve observed several GI providers in my training, but I have to say your approach seems magical! I was so impressed by how well patients responded to you, and their testimonials were inspiring. I’m so glad we are close by. I look forward to collaborating on patient care and will certainly keep you up to date as my clinic gets up and running so we can coordinate behavioral medicine care for your patients in the Charlotte area.
The meetings with Oil and Bill were also very productive. We are all very excited to be a part of the Rome Research Institute and excited about contributing.”
BM: “We had such an energizing time with Doug in the Drossmancenter and learned so much from our just two day clinic visit and lecture.
I came back with several new ideas and better ways I can communicate with my difficult “Functional” bowel patients esp in addressing their psychosocial concerns (rather than avoiding the discussions) and Comorbid pain conditions. I also came back with a lot more confidence in using neuromodulators in my practice but feel I certainly had gaps in my knowledge and will need some ROME help to improve.”
1. What made you decide to go into the Visiting Scholar program?
BM: The visiting scholars program with Dr. Drossman allowed our Atrium Health Team a unique opportunity to experience the set-up of a functional bowel disease program lead by the world expert -Dr. Drossman- himself. We wanted to see first-hand the many exciting opportunities that the ROME Foundation and Dr. Drossman have put in place for educating physicians and other providers in the clinical setting on the effectiveness communication skills and its impact on the physician-patient relationship. His discussions in several meetings throughout my now almost 20 years of training as a motility specialist on the importance of the physician-patient relationship were made more tangible by me visiting his patient-centered clinic and experiencing the outcome of a real-world biopsychosocial care model that Dr. Drossman has emphasized for years. I also wanted to learn more how he uses central neuromodulators in his practice and how he augments patient’s therapy with either therapy or other centrally targeted treatments such as cognitive behavioral therapy. In addition, our team also wanted to meet with two key UNC faculty, Drs. Whitehead and Palsson who are also active ROME members and Founders in hopes of hearing more about the Rome Foundation’s Research Institute and how this will be implemented in the future.
ET: This program is truly unique. It’s not often that we get to engage with leading experts in an intimate, one-on-one training setting – however, the Rome Clinical Scholar’s Program allows us to do so through a unique blend of intensive clinical and research experiences.
As a GI psychologist, I knew there was a lot to gain by coming here. I was excited to be a part of the program alongside my GI Motility colleagues, Baha Moshiree, MD, and Mackenzie Jarvis, PA-C, and knew that we would learn a great deal by observing Dr. Drossman engage and educate patients in real time. I was also thrilled about the opportunity to meet with Drs. Palsson and Whitehead and discuss research interests, share ideas, and brainstorm ways in which we can collaborate, especially given our close proximity here in North Carolina.
MJ: As a new provider I wanted to meet and learn from Dr. Drossman to understand how to interact with patients with open communication and how to work as a team with the patient to improve their care. Coming out of training, patients with functional bowel disease were extremely challenging to me. I wanted to take the opportunity to learn different modalities of treatment including neuromodulators and how to augment patient’s therapy to help their chronic, debilitating pain. We also wanted to learn about new opportunities from the ROME foundation to become more involved.
The team also wanted to meet Mr. Whitehead and Dr. Palsson to collaborate on future research and to learn new research that they were involved in currently.
2. What were your goals and objectives in attending the program?
BM: Observing Dr. Drossman in his clinic and learning how he navigates conversing to his patients with debilitating functional bowel diseases and how he explains to them what it means to have a disorder of Gut-Brain Interaction (DBG).
I wanted to see how Dr. Drossman manages his patients with DBGs whether it is functional chest pain, dumping syndrome, functional heartburn, functional dyspepsia, IBS or levator Ani Syndrome. We had the opportunity to see all of that.
I wanted to learn how Dr. Drossman uses the various neuromodulators for each patient and what considerations go through his mind as he decides on one over another. For example, how he decides on a TCA versus SNRI versus an SSRI.
I wanted to how he structures his sentences to allow for not only open-ended questions which I’ve seen him do in the past but how his mannerisms allow for more open communication between him and his patients.
I wanted to learn how he explains to patients how their childhood trauma experience or their history of any abuse relates to their current DBG and how he will help them alleviate their symptoms and overcome their illness no matter what sort of illness behavior they may exhibit.
ET: As a new faculty at Atrium Health, I will soon be setting up a behavioral medicine program in the Digestive Health department. To help enhance my clinical practice, I hope to improve my knowledge about optimal ways to communicate with patients, as well as learn how to most effectively educate patients about pharmacological (e.g., neuromodulators) and non-pharmacological (e.g., behavioral medicine, diet) approaches to GI care.
I also hoped to have productive meetings with Drs. Palsson and Whitehead to discuss ways in which our research agendas overlap and identify how we can work together to promote novel, GI-related research in real-world settings.
MJ: Build patient-provider communication skills when discussing difficult functional bowel diseases that are often confusing for patients.
Understanding how to explain a disorder of the Gut-Brain Interaction
To learn how to incorporate medical therapy into functional GI disorders along with psychological treatments
I wanted to understand how Dr. Drossman managed patients with challenging functional bowel diseases
How to help patients understand the role of neuromodulators for their condition and different approaches to their GI care with the additional of our GI Psychologist
3. To what degree were these goals/objectives met? Please describe?
BM: The multidimensional component of many of the disorders Dr. Drossman treats were experienced by our team in real-time throughout this Rome Scholar Visitorship. Unfortunately I was only able to attend two days of these sessions but even in those two days I learned important skills that either I had forgotten about since I rotated with Dr. Drossman in my much younger years (med school and GI fellowship) or I had never learned despite the knowledge that I currently have about pharmacologic management of DBGs. I am so grateful that I had this opportunity. I came back energized and poised to see my patients with IBS and bloating and describe their disorder to them in the non-judgmental and open way that Dr. Drossman communicated his. This experience certainly makes me a better physician and I feel that in our practice where the chronic and debilitating nature of the disorder often burns us out as it disappoints our patients, it is important to be reminded of the ways in which simple features of communication which Dr. Drossman demonstrated to us: engagement, empathy, validation and education can lead to high patient satisfaction. I am still blown away that Dr. Drossman gives his patients his cell number and was a witness to every patient who left his office feeling empowered and in control of their disorder. I learned how he handles patient’s fears of abandonment and helps them understand the chronicity of their disease while finding ways to treat thru their “illness behavior”. He really is either a Genie or a genius or both.
ET: My goals/objectives were not only met, but the Rome Clinical Scholars program exceeded my expectations. Observing Dr. Drossman in clinic was invaluable. His ability to connect with patients, educate them, and provide a unique intersection of GI and psychiatric care, is like nothing else I have seen before. It’s magical. I definitely mentally noted several of his educational and rapport-building strategies for my own clinical practice in the future.
MJ: Dr. Drossman has shaped my clinical practice as a new provider to incorporate open communication and how to educate patients on their condition in a way that patients are open to the conversation concerning different modalities of treatment. The experience surpassed my goals and expectations. Witnessing patients with chronic debilitating pain that now have their life back after being treated by Dr. Drossman is amazing. I now understand the role of neuromodulators and their role in treating functional bowel disease. I feel more confident when discussing the Gut-Brain connection with patients and how their past experiences may contribute to their condition.
4. What were the most meaningful aspects of your experience?
BM: All of it! See number 3. I need more time (clinic time) with Dr. Drossman in the future to really learn how he utilizes the augmentation therapies with neuromodulators but we did come back with several good pointers
On use of neuromodulators for pain and to address important comorbid conditions such as sleep or migraines for example.
It was also an added treat to be able to meet with Drs. Whitehead and Dr. Palsson as we are building our own motility and functional bowel programs in Charlotte and discuss with them our interest in participating in the Rome Foundations Research Institute given our unique community setting. Along with Elyse Thakur, our newly hired behavioral psychologist and Mackenzie Jarvis- PA doctorate who will be also seeing patients in our digestive health clinics, we were able to discuss several research projects in the future that would benefit from Drs. Palsson and Whitehead’s expertise. They were very excited to share their knowledge with us and I truly appreciate the time they spent with us during our visit.
ET: This is a loaded question; however, I will do my best to answer it succinctly. ☺ It was incredibly meaningful to have one-on-one time with Dr. Drossman. The opportunity to not only observe him in clinic, but to be able to “pick his brain” about his case conceptualization and treatment focus, was invaluable. I also very much appreciated hearing patient testimonials that were unsolicited. After seeing 4 or 5 patients come through, I could really appreciate the impact Dr. Drossman has on his patients and the greater GI community. Further, the ability to observe how Dr. Drossman handled complex GI cases was extremely useful. It helped me to think through ways in which it is important to prioritize issues presented by patients who have several, competing issues. Dr. Drossman’s generosity and willingness to educate us is unforgettable! He is a special mentor, and we are forever grateful to be able to follow in his footsteps.
Further, I found it meaningful to share research interests with Drs. Palsson and Whitehead. As a young, GI psychologist, I look up to them and am so honored to have been able to connect with them through Rome. I greatly admire their accomplishments, and value their expertise and feedback. Therefore, it was an incredible opportunity to be able to sit down with them, hear about their work, share ideas, and think through next research steps. I am very eager to incorporate clinically relevant research into our new behavioral medicine program at Atrium, and I am excited and grateful that Drs. Palsson and Whitehead will provide support and mentorship along the way.
MJ: During my time observing Dr. Drossman he quizzed me on rectal pain levator ani syndrome vs. proctalgia fugax, I unfortunately did not have the full answer to his question. He took the time to explain the difference and how he manages patients with the condition. Today in clinic I saw a patient that I diagnosed with proctalgia fugax and was able to explain the condition to the patient. Even in a short time period with Dr. Drossman I gained valuable clinical knowledge to help my patients.
Additionally, learning vital communication skills with patients is extremely meaningful as a new clinician. I will take the skills that I learned from not only watching him in clinic, but watching his videos on communication skills and incorporate the language into my everyday practice.
Meeting Dr. Whitehead and Dr. Palsson was a great experience and we are very excited to collaborate in future research. We shared interest in participating in the Rome Foundation Research Institute and other research projects.
5. Do you have any further recommendations for us so that we may improve the program?
BM: I will be excited to hear more about the RFRI as this evolves and how different FGID programs can participate in this worthwhile endeavor. I know this is in the preliminary stages and I am happy to connect Dr. Palsson also with other international colleagues not listed already.
How will you use this information in building your own program?
I certainly plan on using what I was able to learn from Dr. Drossman in such a short time span in my practice now. In addition, collecting prospective data via questionnaires already developed by ROME IV is a goal of ours and as the RFRI expands we hope to also participate in the biobank and patient registries that will be entered around the world. This clinical research network is the future of world class clinical research and we are very excited to do our part to participate in this global effort. In addition, I am excited to register for the Rome Foundation Symposium to be held in Atlanta where I can have more interaction with course speakers. I am hoping our program director makes it a requirement for our fellows to watch Dr. Drossman’s videos on effective patient communication. I find this so much more useful that the blood-borne pathogen or conflict of interest modules we do yearly as part of our employment requirements as providers. There certainly is not enough time spent (maybe none) on teaching our fellows this vital communication skills that they will use frequently once they graduate. I feel this is a huge gap in our teaching curriculum and I am glad to see that ROME has made it a center focus.
ET: This program is fantastic. The only recommendation I have is to advertise it widely! If I had not personally known Dr. Drossman, I may not have known it was an option.
MJ: As a new PA I believe it would have been helpful to watch Dr. Drossman’s communication skills videos during my training. The videos should certainly be utilized in training programs around the Country
6. How will you use this information in building your own program?
BM: I certainly plan on using what I was able to learn from Dr. Drossman in such a short time span in my practice now. In addition, collecting prospective data via questionnaires already developed by ROME IV is a goal of ours and as the RFRI expands we hope to also participate in the biobank and patient registries that will be entered around the world. This clinical research network is the future of world class clinical research and we are very excited to do our part to participate in this global effort. In addition, I am excited to register for the Rome Foundation Symposium to be held in Atlanta where I can have more interaction with course speakers. I am hoping our program director makes it a requirement for our fellows to watch Dr. Drossman’s videos on effective patient communication. I find this so much more useful that the blood-borne pathogen or conflict of interest modules we do yearly as part of our employment requirements as providers. There certainly is not enough time spent (maybe none) on teaching our fellows this vital communication skills that they will use frequently once they graduate. I feel this is a huge gap in our teaching curriculum and I am glad to see that ROME has made it a center focus.
ET: I will most certainly use what I learned to teach GI providers patient-provider communication skills and educate them about how to successfully initial referrals to behavioral medicine. I will also model my psychoeducation sessions after Dr. Drossman, so I can most effectively build rapport with patients, and get them on board with behavioral medicine treatment. I also greatly value the support and expertise of Drs. Palsson and Whitehead, and plan to continue to engage with clinically relevant research endeavors in our community-based hospital setting in Charlotte.
Much like Dr. Drossman’s patients, I left hopeful, excited, and inspired about what we can do next. Thank you, Drs. Drossman, Whitehead, and Palsson and the entire ROME Foundation for allowing us to partake in this truly special training experience. What a treat!
MJ: The information that I learned in the short amount of time spent learning from Dr. Drossman was astonishing and will add value to my everyday patient visits. My first clinic day back from the visit I used vital communication skills that I learned from Dr. Drossman. After incorporating open ended questions with change in my body language patient’s opened up about their histories of abuse, loss and psychological conditions that they had not shared with me before. Watching Dr. Drossman’s videos on effective patient communication has certainly improved my skills as a new healthcare provider.
All: We truly appreciate the time Dr. Drossman, Dr. Whitehead and Dr. Palsson took out of their time to spend with us. It was an extremely valuable experience that has made a difference in our everyday practice.