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 [1]. 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.
References:
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
I’ve seen similar results in studies on acupuncture and other alt-med modalities. The more emphatic the practitioner is and the more time they spend with the patient the better the outcome. I think this little piece of research conclusively summarizes how alt-med works.
Only sorry I didn’t come to you when I got tested for thyroid – Dr agreed to me having a test (if it makes you feel happy) and when the results came back, the receptionist would not put me through to speak to my doctor – ‘we have your results here, there is nothing wrong, and no further action will be taken!’
Fortunately I felt sick enough to go and find a second opinion, and got some good advice and help. Wish I could find a second opinion on another problem I have.
Perhaps the association noted in the study is finding a secondary effect. Perhaps the primary correlation is that more empathic doctors are better observers and are more willing to take risks (e.g., discount lab test results) on behalf of their patients.
I am amazed there are not more comments on this. As far as I am concerned the attitude of any medical practitioner is absolutely crucial. If I feel I am going to be treated to the party – government – line and not be credited with having researched the subject myself, I will have no confidence in the advice/opinion. With a recent eye problem the first consultant I saw had his view and dismissed the route which I wanted to follow saying that he did it this way. A second consultant listened, discussed, we exchanged detailed emails, and his approach was that he wanted me to feel happy with the course of action he proposed. The outcome has been extremely successful. I was in the fortunate position of being able to visit both consultants privately although both also work in the NHS. I feel very sorry for those people not able to do this who are stuck with the attitude of the first consultant.
Before anything else, I want to say always work WITH your doctor in medical matters should you consider change.
Around the age of 42 I was told I had an underactive thyroid (problem taking me to GP were loose stools day-long). I was physically fit as a flea, a yoga teacher for many years. I was put on the top dose of thyroixine (T4) and for four years thereon I felt like a very old woman, devastating. Dreadfully stiff joints, exhaustion, unable to wake up in the morning, stairs felt like mountains etc., etc. The GP suggested it was ME and left me to it. Eventually a homeopath recognised the problem (having suffered in exactly the same fashion herself) and I was cured. My original GP had refused to work with me on this. His replacement accepted my choice, but was concerned that my bloodtest still showed my thyroid underactive. He sent me to Barts to try T3 , an alternative to T4, on a very low dose to start. One week of treatment and the same reaction set in. I agreed to give it a month, but then came off it. The consultant at Barts called me an enigma, but I’m obviously not. Stemming from Barts’ bloodtests I still have B12 jabs, and that’s it. Still fit as a flea. I hope this proves useful to others on Thyroxine. I’d say always work WITH your doctor in these matters should you consider change. If they don’t find another. A GOOD doctor will agree.
To Kay Russell
I think the whole point of the Italian study is not just that patients need to work with their doctors, but that doctors need to work with their patients.