Over time we develop unique ways of managing patients but rarely share our methods. With two pages free in this issue of Frontline Gastroenterology I outline my own unique tips on management of patients with medically unexplained symptoms and invite comment on whether this type of article should be a regular feature.

1. Bristol Stool Scale Until discovering the Bristol Stool Scale I spent many hours asking patients detailed questions about their stool. The Scale is worth a 1000 questions and I would no longer be in clinic without it. Patients' descriptions of their stool are often at variance with the Scale, and using the Scale is much faster than asking questions. The Scale provides a good estimate of transit time for constipated patients. It is easier using the Scale to explain constipation in terms of transit time and how it should be managed. Patients complaining of persistent diarrhoea with occasional type 1 (hard pellets) stool are almost certain to have an irritable bowel. This crucial …