Table 5. Patient and provider vignette: an alternative path.

Patient perspective	Provider perspective
A) Sarah makes an appointment at a hospital in the next town over and is given a 1-hour new patient appointment with Dr. Beeleaf. When she speaks to the receptionist, she is told the office will take care of all prior authorizations and will request her records be sent over. The receptionist reassures Sarah they will work together to figure this out and Sarah already begins to feel more relief. Sarah arrives to her visit with Dr. Beeleaf and is brought into the office	B) Not long before Sarah made her appointment, the hospital had made numerous changes in their departments to support patients and providers. The GI department hired a full-time psychologist, and nutritionist. They were also given funding for additional support staff and their entire team was provided with training to understand the whole-person perspective of GI symptoms including the role of the mind-gut connection. Additionally, changes were made to providers’ schedules which allowed for one-hour new patient appointments and reductions in over-booking providers. As a result of these changes demand for care increased. Instead of placing the burden of this demand on the providers, the hospital instead released funds to hire additional physicians. Dr. Beefleaf sits down, faces Sarah, and listens as Sarah recounts her medical history and experiences. “I’m so sorry all of this is happening, Sarah. I have no doubt your symptoms and pain are real and I’m hopeful we can get some solutions. I’m curious, though, when your symptoms started was there anything big going on in your life? Any changes or stressors?”
C) “So, wait, I'm causing this because I can’t handle my stress?” Sarah asks	D) “No, that’s not what I’m saying at all. Let me be clear you did not cause any of this. Stress can just be a factor that makes these symptoms worse and so that’s something we want to address while we also treat you medically. As people we aren’t just physical or mental, our mind and our body influence one another and so we want to make sure we are addressing both. We have a psychologist on staff in our practice for this reason and if you’re okay with it I think it would be helpful to meet with them to talk through what you’ve been experiencing. While they work with you, I will also be running tests and working on medical interventions that can help.”
E) Sarah thinks about this, she hadn’t been asked before, but she realizes her symptoms began around the same time her company was conducting layoffs and her mom was in an accident with a drunk driver. She tells this to Dr. Beeleaf	F) “Okay, that makes sense, and I’m not in any way saying the stress you were under were the sole cause of your symptoms, but we do know stress can influence physical symptoms.” Dr. Beeleaf goes on to explain the role of the mind-gut connection. As Dr. Beeleaf is explaining, Sarah recalls other times she experienced more severe pain and noticed it did tend to happen when she was stressed or anxious
G) Sarah takes a sigh of relief and agrees with Dr. Beeleaf’s plan. She makes an appointment with the clinic’s psychologist and nutritionist and leaves the appointment feeling she is in good hands with this clinic and this team. Over time Dr. Beeleaf also tells Sarah she suspects Sarah has IBS-D and recommends options to help Sarah with her symptoms. Sarah, knowing and trusting Dr. Beeleaf follows her advice, continues to work with the psychologist and in a few months, she is starting to feel much better

GI, gastroenterology; IBS-D, irritable bowel syndrome associated with diarrhea.