Looking Beyond the Scope: Integrated Care & Women's Health in Gastroenterology

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Dr. ChutkanGastroenterology has grown to be a field closely intertwined with endoscopy, but physicians are increasingly looking beyond procedures to new service lines for ways to provide the best possible patient care.

Robynne Chutkan, MD, board-certified in gastroenterology and internal medicine and author of Gutbliss, describes her approach to integrated patient care and her work with women's health in the field of GI.  

Women in the GI Field
Dr. Chutkan completed her fellowship training in 1997. "At this time, it was not uncommon for hiring practices to view women as a liability," she says. But, as she began to practice at Georgetown University Hospital, she was immediately busy. Female patients were eager for a female GI physician. "We have gone from being a liability to an asset and that shift has really been patient-driven," says Dr. Chutkan. Research has shown a high level of gender concordance in the field of gastroenterology; women are willing to pay more and wait longer to see a female physician.

In practice, Dr. Chutkan grew to realize that the female patient base in GI is large and unique from that of a general patient base. After eight years of successful practice at Georgetown, Dr. Chutkan founded the Digestive Center for Women in Chevy Chase, Md.

Integrated Care
The spark that drove Dr. Chutkan to open the Digestive Center for Women was an accumulation of her patient experiences. She noticed female patients coming prepared with lots of questions on a regular basis. What should I be eating? How does my stress level affect my GI tract? What can I do to change my lifestyle accordingly? "GI physicians just coming out of training often don't know how to answer these questions," says Dr. Chutkan. "There is a disconnect between the training physicians are receiving and the questions patients are asking."

Dr. Chutkan's practice now offers services to answer these patients' questions. Services include:

•    Nutrition counseling
•    Stress management
•    Biofeedback
•    Exercise physiology
•    Weight management programs

Dr. Chutkan often sees patients that have come from another GI physician after undergoing an endoscopy or colonoscopy and receiving a prescription. The step towards preventive care has often not been explored. "Patients are hungry for this information," says Dr. Chutkan.

Although the center is called the Digestive Center for Women, its patients are now about 20 percent male, as both men and women alike are seeking a more comprehensive approach to medical care.

Once Dr. Chutkan realized patients were seeking answers to questions her training had not prepared her for, she sought to learn more. As she incorporated ideas such as nutrition and stress management into her practice, she realized she was wearing a few too many different hats. An essential element of integrated care is branching out and collaborating with different medical professionals such as:  

•    OB/GYNs and urologists: Women often experience pelvic floor issues. Gastroenterologists can benefit from their expertise.
•    Nutritionists: Diet is an essential tool in treating digestive disorders. Nutritionists serve as a valuable resource.
•    Exercise physiologists: Obesity affects every part of the digestive tract. Exercise can be key in managing GI issues.
•    Psychologists: Exploring the emotional aspects of digestive diseases can be a key part of getting the symptoms under control.

"If a patient presents with abdominal pain and you are coming up blank, you need to consider picking up the phone and reaching out to a colleague in another specialty," says Dr. Chutkan.

Broadening Horizons
Physicians frequently attend and speak at medical conferences. "Gastroenterologists attend so many digestive disease meetings, which are very useful, but the information is often already within our purview," says Dr. Chutkan. "We need to step outside of that." She attended a meeting called Food is Medicine and learned a great deal of information. "It was life-changing," she says.

Patients often look elsewhere because conventional medical has failed them. Regardless of whether or not physicians incorporate alternative services into their practice, the knowledge is a useful instrument. "You are armed with an additional perspective and more tools with which to better serve your patients," says Dr. Chutkan.

Balancing the Scale
Colonoscopy has become such a dominant trend in the field partly because of how physicians receive reimbursement. "Currently, physicians are not well compensated for talking to patients and highly compensated for performing procedures, but this is changing," says Dr. Chutkan.

Reimbursement trends are shifting and heavy reliance on a single procedure is becoming a less viable long-term strategy. Diversity within a GI practice also enhances a physician's ability to place the patients' interests first. "When so much of a physician's income relies on a single procedure, it can become a conflict of interest," says Dr. Chutkan. "You know what you will make for a colonoscopy versus a simple patient visit. This discrepancy can be a powerful motivating factor for doing more procedures and spending less time exploring the non-endoscopic aspects of the patient's illness."

Less than 200,000 people a year are diagnosed with colorectal cancer, but millions of Americans struggle with obesity and conditions like irritable bowel syndrome. If routine procedures fill a physician's schedule, there is little time to see and speak to patients with a wide variety of complex GI conditions, such as Crohn's disease or those relating to obesity. "Colonoscopy screening is an invaluable tool that saves lives, but we need more balance. Patients with other GI disorders are not always getting the attention they need," says Dr. Chutkan.

More Articles on Gastroenterology:
2014 Outlook: 7 Issues for Gastroenterologists to Focus on This Year
The Future of GERD Treatment & TIF: Q&A With Dr. Gilbert Simoni of Los Robles Hospital
Dr. Caroll Koscheski of ACG: Value-Based Care in Gastroenterology

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