I was talking with someone about medical education yesterday, and was making the point that however much knowledge a doctor has stuffed in their head, it matters little if they are unable to communicate that knowledge effectively. Being able to effectively convey your thinking to clients and colleagues is a key skill for good medical care, I think, but I fear we doctors often fall down here (especially in our communication with patients). I think other things are important too, like actually listening to your patients, engaging them in the decision making process and even, where relevant, asking them what they think the problem is.
If I were to add another key quality to good medicine it would be that doctors should care about the outcome of their care and advice. Earlier this week I was talking with the father of a patient about the management of low thyroid function (hypothyroidism). I made the point that some endocrinologists are quite fixated on judging the status of someone’s thyroid function by blood test results alone, even though these tests are often inadequate and sometimes misleading. It’s not that uncommon to see a patient whose test results are normal, but who appear to be very obviously suffering from low thyroid function. Slavish adherence to thyroid hormone ‘normal ranges’ means that these patients may go without medication that could lead to huge improvements in their symptoms and quality of life.
Last week I was talking to a doctor who asked me how I would justify treating someone with thyroid hormone even when tests results were normal. I told him I’d justify it by understanding the deficiency of testing, what I see before my eyes and then (I hope) the clinical improvement I see in the patient and what the patient tells me.
I was reminded of these conversations yesterday when I came across a piece of research which assessed the relationship between the amount of empathy doctors exhibit and outcomes in patients with diabetes . This Italian study assessed this relationship in almost 21,000 diabetic over a year-long period. The outcomes the researchers assessed were signs of poor diabetic control including ‘diabetic ketoacidosis’ (uncontrolled type 1 diabetes), coma, and ‘hyperosmolar state’ (raised blood sugar levels). Together, these issues can be described as ‘acute metabolic complications’.
Compared to patients of physicians with low empathy scores, patients of those with high empathy scores had a 41 per cent reduced risk of acute metabolic complications. The authors of the study conclude that:
These results suggest that physician empathy is significantly associated with clinical outcome for patients with diabetes mellitus and should be considered an important component of clinical competence.
Caring not just for but about people is, I believe, a key aspect of good medicine. Unfortunately, unlike facts and figures, it’s not something that I believe can be learned so easily.
1. Canale SD, et al. The Relationship Between Physician Empathy and Disease Complications: An Empirical Study of Primary Care Physicians and Their Diabetic Patients in Parma, Italy. Acad Med. 2012;87(9):1243-1249