Narrative Summary: Patients often seek urgent evaluations for acute flares of chronic conditions (e.g. functional abdominal pain, migraine headache), and often see physicians they have never met. This interactive workshop will allow participants to share challenges and gain skills in their abilities to rapidly establish trusting therapeutic relationships and provide appropriate, evidence-based care, using a structured framework for categorizing and evaluating symptoms. We will outline essential steps for patients to understand and accept the biopsychosocial aspects of chronic conditions, to be confident that the evaluation has been adequate to rule out other organic conditions while minimizing unnecessary testing, to accept the limitations of therapy and incremental improvements of symptoms, and to engage in effective self-management. We will encourage all participants to share challenges, stories, and their own best practices in similar settings, and learn from one another.

Background Mayo Clinic, best known as a tertiary care center, also provides primary care to a local population of over 140,000 patients. We have found that patients frequently seek urgent evaluations (including testing) for what are often acute flares of chronic conditions (irritable bowel syndrome, atypical chest pain, migraine headache, etc.). These diagnoses have sometimes not been made at all or at least have not been fully understood by the patient, and continuity is lacking. Consequently, patients are often given appointments with physicians with whom they are barely, if at all, acquainted, and may end up with unnecessary testing, additional diagnoses, and inadequate follow-up.

Objectives Using irritable bowel syndrome as an example, and following a 12-step framework we have developed, participants will sharpen the skills which will help then recognize these patients, establish trusting therapeutic relationships in the first minutes of the visit, and provide appropriate, evidence-based care. This in turn helps patients begin to understand the biopsychosocial aspects and specific features of chronic conditions, to be confident that the evaluation has been adequate and with all necessary testing having been done, to accept the limitations of therapy and incremental improvements of symptoms, and to engage in effective self-management.

Methods This interactive workshop is designed to allow all participants to share challenges, stories, and their own best practices when facing similar situations. In the past, utilizing an experienced moderator and effective time management, we have been able to successfully engage the audience through questions and shared experiences, ensuring that all objectives are addressed and that participants are able to learn from one another.