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Using a Treat-to-Target Management Strategy to Improve the Doctor–Patient Relationship in Inflammatory Bowel Disease

Rubin, David T MD, FACG1,2; Cleveland, Noa Krugliak BS1,3

American Journal of Gastroenterology: September 2015 - Volume 110 - Issue 9 - p 1252–1256
doi: 10.1038/ajg.2015.86

The doctor–patient relationship (DPR) in inflammatory bowel disease (IBD) has been facing new challenges, in part due to the substantial progress in medical and surgical management and also due to the rapid expansion of patient access to medical information. Not surprisingly, the complexity of IBD care and heterogeneity of the disease types may lead to conflict between a physician’s therapeutic recommendations and the patient’s wishes. In this commentary, we propose that the so-called “treat-to-target” approach of objective targets of disease control and serial adjustments to therapies can also strengthen the DPR in IBD by enabling defined trials of alternative approaches, followed by a more objective assessment and reconsideration of treatments. We contend that such respect for patient autonomy and the use of objective markers of disease activity improves the DPR by fostering trust and both engaging and empowering patients and physicians with the information necessary to make shared decisions about therapies.

1University of Chicago Inflammatory Bowel Disease Center, Chicago, Illinois, USA

2University of Chicago MacLean Center for Clinical Medical Ethics, Chicago, Illinois, USA

3University of Illinois at Chicago, Chicago, Illinois, USA

Correspondence: David T. Rubin, MD, FACG, The University of Chicago Medicine, Inflammatory Bowel Disease Center, 5841 S Maryland Avenue, MC 4076, Chicago, Illinois 60637, USA. E-mail:

Received 06 November 2014; accepted 01 February 2015

Guarantor of the article: David T. Rubin, MD, FACG.

Specific author contributions: Both David Rubin and Noa Krugliak Cleveland contributed equally in developing the concept, writing, and editing of this manuscript.

Financial support: None.

Potential competing interests: None.

© The American College of Gastroenterology 2015. All Rights Reserved.
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