A recent review of clinical trials reveals that a doctor's bedside manner can greatly impact patients' health, aiding their efforts to lose weight, lower their blood pressure, or manage painful symptoms.
Physicians: Nine reforms to improve doc-patient relationships
For the review, published in the journal PLOS One, researchers examined 13 randomized, controlled trials that involved "hard outcomes," such as variation in blood pressure or weight loss, and compared them to trials with subjective measures, such as patient satisfaction or reported pain scores. In most studies, health care providers were randomly assigned either to:
- Provide their usual care; or
- Receive some type of training on patient interaction, including general skills like building empathy and maintaining eye contact, as well as specific relationship-based strategies like motivational interviewing and goal setting to achieve specific health outcomes.
The review found that relationship-focused training had a small but statistically significant effect on the specific health outcomes in patients with obesity, diabetes, asthma, or osteoarthritis. Among other things, it could affect weight loss, blood pressure, blood sugar and lipid levels, and pain.
In fact, the researchers noted that the impact was greater than the reported effects of low-dose aspirin or cholesterol-lowering statins for preventing heart attack.
The pitfalls of poor bedside manner
"Our results show that the beneficial effects of a good patient-clinician relationship on health care outcomes are of similar magnitude to many well-established medical treatments," says lead author John Kelley, a psychologist at Massachusetts General Hospital. He added that "many of these medical treatments, while very important, need to balance their benefits against accompanying unwanted side effects. In contrast, there are no negative side effects to a good patient-clinician relationship."
Bottom line: The provider-patient relationship matters
The review did not discover which interventions provided the most benefit, notes Alan Christensen, a professor of psychology at the University of Iowa who was not involved in the study. He added that patients differ in what characteristics make a "good" doctor, including how much information they want shared, their views on self-management, and how open they are to personal questions.
However, Christensen—along with Helen Riess, the senior researcher on the new study—agree that the study speaks to the importance of the clinician-patient relationship. "Patients need to understand that it's OK to look for a doctor who meets your preferences and expectations," Christensen says.
Riess stressed that patients should speak up if they're unhappy with their provider. She says, "Patients should feel empowered to say, 'I didn't understand that language you used. Can you explain it in laymen's terms?'" (Norton, HealthDay, 4/10; Medical Xpress, 4/10).
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Daily roundup: April 14, 2014