Ways to Improve the Patient–Physician Relationship

Gricelda Gómeza; Emilio Aillachb


Curr Opin Psychiatry. 2013;26(5):453-457. 

In This Article

Clinical Empathy

One of the areas of research of the PPR that has awakened progressively greater interest is to elucidate how and to what extent the empathic ability of the physician impacts the clinical outcomes of the patient. Empathy is conceptualized as a factor of process in the PPR and is used as a cognitive skill to understand and communicate the emotional keys of the patient;[25] the evidence suggests that physicians with a greater level of empathy can obtain better clinical outcomes in their patients. Hojat et al.,[26••] in a correlational study with 891 diabetic patients, found that those patients of physicians with higher empathy scores were significantly more prone to a good control of their A1c hemoglobin levels (56%) than the patients whose physicians had low empathy scores (40%; P < 0.001), which is the same as the proportion of patients with good control of low-density lipoprotein cholesterol (LDL-C) (59 vs. 44%; P < 0.001). Another correlational study allowed the increase and complement of the validity of the findings described in this population of diabetic patients. Del Canale et al.,[27••] in a sample of 20 961 diabetes mellitus type 1 or 2 patients, confirmed that the patients of physicians with high empathy scores presented a lower rate of acute metabolic complications in comparison to the group of patients treated by physicians with low empathy scores. It becomes necessary to indicate that the same physicians obtained the empathy scores by means of self-applied instruments.

In the same way, similar and even more relevant conclusions can be reached when patients are in charge of the evaluation of the doctor's empathic skill and, in general, of the therapeutic process. In fact, we should remember that the PPR, as well as any other helping relationship, is an open and dynamic system in which the effectiveness of the relation depends on the functional articulation of the variables that are present in both doctors and patients.[28] In the past decade, the non-specific factors of the clinical context that may have caused relief, change or recovery in the patients are being thoroughly studied, especially those with experimental design. In particular, the research line about the placebo effect – which is as much an intermediate product like an emerging phenomenon on the PPR field of study – is trying to elucidate which are the mechanisms that explain how it changes the patient's experience of the illness, and his perception of the symptoms.[29,30]

For the relevance of their findings, from this area of research are derived a set of highly promising studies; in an interesting randomized clinical trial of 719 patients with a common cold, Rakel et al.[31••] observed that, in the intervention group of patients who received an increase in behaviors that expressed empathy and closeness of their physicians, a greater number of physicians with maximum empathy scores was seen, in comparison with the control group of patients who received a standard visit by their treating physicians. In the intervention group, they found marginal associations in terms of a shorter length and lower intensity of the cold than in the control group. This research added the assessment of interleukin (IL)-8 levels and neutrophil count, observing a trend towards a greater positive change in the intervention group, though it did not reach statistical significance. An even more striking and surprising result, when regrouping the physicians according to their empathy scores into perfect and not perfect, it was observed that, in the group of treating physicians with maximum or perfect scores, their patients showed a significant increase in the IL-8 levels and neutrophil count, and better subjective clinical outcomes in terms of length and intensity of symptoms.