by Helen Riess and Diego Reinero
The patient-clinician relationship is a subject that receives much attention in the news, from patients, medical academics, clinicians, and healthcare focused organizations. However, advances in technology, increasing automaticity, and burnout among medical professionals can often eclipse empathic, person-centered care. The patient-clinician relationship has been shown to affect patient satisfaction, adherence to treatment, and other intermediary measures, but skeptics often question its relevance to “hard” medical outcomes.
Supported by a grant from The Gold Foundation, we conducted a study that was published on April 9, 2014 in PLOS ONE. The paper is titled The Influence of the Patient-Clinician Relationship on Healthcare Outcomes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and our results suggest that the patient-clinician relationship has a significant effect on healthcare outcomes.
Although it has long been believed that a good patient-clinician relationship can improve health outcomes, most previous studies or reviews have been observational studies – recording aspects of clinical encounters and any potential associations with health outcomes – which cannot prove whether observed differences actually caused any outcome changes. Some studies have examined intermediate measures such as how well patients understood advice they were given or how satisfied they were with their care, but did not look at whether or not there were any health improvements.
Our review focused on randomized controlled trials, considered the gold standard for medical research. In these trials the patient-clinician relationship was systematically manipulated (e.g., improved communication skills, increased empathy, better attention to nonverbal signals, not interrupting, etc.), and where there was either an objective outcome measure (e.g., blood pressure) or a validated subjective measure (e.g., pain scores). Our review criteria led to a final selection of 13 trials.
The studies – which involved care of patients with conditions like diabetes, hypertension, asthma, and osteoarthritis – examined the impact of interventions, which trained clinicians in a variety of relationship-based techniques. Some of these interventions were focused on the relationship itself, like making more eye contact with patients and attending more closely to their emotions, while others used relationship-based strategies such as motivational interviewing and goal setting to address the health issue in question. All included studies compared the outcomes in an interventional group (in which physicians, nurses or other health professionals received training) to those of a control group delivering standard care.
Our meta-analysis found that relationship-focused training had a meaningful effect on measured health outcomes – factors such as weight loss, blood pressure, blood sugar and lipid levels, and pain – in patients with conditions such as obesity, diabetes, asthma or osteoarthritis. Interestingly, we found that the size of the effect of the interventions was greater than previously reported effects of aspirin in reducing the incidence of heart attack over five years or the influence of statins on the five-year risk of a cardiovascular event.
We think these results carry profound implications for how clinicians treat their patients. General empathy in a meaningful patient-clinician relationship appears to improve patient’s well being, both emotionally, and now, physically. On a micro level, a clinician’s interactions with a patient should be viewed as an opportunity to improve that patient’s health; on a macro level, hospitals should emphasize the importance of the patient-clinician relationship in their overall healthcare delivery to achieve the best possible outcomes and improve patient satisfaction. While there may never be a silver bullet to cure the ailments of patients, our review underscores the importance of this humanistic dimension of healthcare.
Helen Riess, MD. is the Director of the Empathy and Relational Science Program at Massachusetts General Hospital and an Associate Professor at Harvard Medical School. Dr. Riess was awarded the 2013 Partners Healthcare Medical Education Research Award and has presented her work nationally and internationally, recently giving a TEDx talk titled, “The power of empathy.”
Diego Reinero, BS. is the clinical research coordinator of the Empathy and Relational Science Program at Massachusetts General Hospital. His research interests include empathy, morality, and prosocial behavior.