He shuffled in, sat down heavily and fixed me with a watery stare.  ‘You know them pills you gave me last time, doc?’  He sucked in his breath noisily and shook his head.  ‘No good!  They made me worse.  I wasn’t able to go for a week.  So I stopped taking them.’

Now this was the fourth prescription I had given Ted in as many weeks and it was becoming clear to me that nothing was likely to work.  In fact, it almost seemed that he didn’t want it to work. We were engaged in a therapeutic dance where the only gain was that our caring relationship might go on forever.

Of course, what often tends to happen is that after the doctor has run out of options, patients with IBS is sent off for more tests or referred to gastroenterologists or dietitians. The whole paso doble starts all over…