Irritable bowel syndrome (IBS) significantly diminishes health-related quality of life (HRQOL). Current management guidelines suggest routine HRQOL screening in patients with IBS. However, data reveal that many providers do a poor job of performing an adequate biopsychosocial history review and that surprisingly few accurately assess HRQOL in IBS. A practical limitation in the busy outpatient setting is that many clinicians have neither the training nor time to accurately assess HRQOL with the appropriate methodological rigor and instead substitute clinical gestalt for objective measures of HRQOL. In this article, Spiegel et al therefore sought to identify a concise list of highly significant determinants of HRQOL in IBS. In a retrospective analysis of over 700 patients with IBS, the authors found that HRQOL was associated with abnormalities in sexuality, mood, anxiety, and chronic stress and was not determined by any of the traditionally elicited gastrointestinal symptoms, any demographic characteristics, or any health resource utilization characteristics. These findings suggest that rather than focusing on physiological epiphenomena (eg, stool characteristics and subtype of IBS) and potentially misleading clinical factors (eg, age and disease duration), physicians might be better served to gauge global symptom severity, address anxiety, and eliminate factors contributing to chronic stress in IBS.