Patients with the Common Cold: Empathy Heals Faster
Patients with the Common Cold: Empathy Heals Faster
Abstract & Commentary
By Joseph E. Scherger, MD, MPH, Clinical Professor, University of California, San Diego. Dr. Scherger reports no financial relationship to this field of study.
Synopsis: A randomized controlled trial demonstrated that "perfect" empathy with patients results in a better immune response, reduction of symptoms, and faster recovery from a common cold.
Source: Rakel DP, et al. Practitioner empathy and the duration of the common cold. Fam Med 2009;41:494-501.
Empathy is a cornerstone of medical practice, but something that is considered more a part of the art of medicine than its science. Investigators at the University of Wisconsin performed a randomized controlled trial in 2 primary care clinics that added empathy to encounters for patients with the common cold. Three hundred fifty patients age 12 and older were randomized to a standard and an empathy-enhanced physician visit. The treatment group physicians were trained in delivering empathy as defined by Mercer and Reynolds: "the ability to understand a patient's situation, perspective, and feelings (and their attached meanings); to communicate that understanding and check its accuracy; and to act on that understanding with the patient in a helpful and therapeutic way."1
The patients rated the degree of empathy using the Consultation and Relational Empathy (CARE) measure. CARE assesses 10 areas of empathy on a scale of 1 to 5: 1) made patients feel at ease, 2) allowed them to "tell their story", 3) really listened, 4) were interested in them as a whole person, 5) fully understood their concerns, 6) showed care and compassion, 7) were positive, 8) explained things clearly, 9) helped them take control, and 10) helped create a plan of action. Eighty-four patients rated their encounter as a perfect 50 and this group was compared with the rest.
The duration and severity of the cold was measured in two ways. The patients self-reported their symptoms at baseline and twice daily for 14 days using the Wisconsin Upper Respiratory Symptom Survey.2 The patients' colds were considered ended if they gave two consecutive "No" responses to the question, "Do you think you still have a cold?" The patients' immune responses were measured using interleukin 8 (IL-8) from a nasal wash done at enrollment and at a follow-up visit approximately 48 hours later. IL-8 is an inflammatory cytokine found in nasal secretions that rises rapidly with upper respiratory infections and then falls over days to weeks. This correlated with the determination that the patients had a cold by having one of the following four symptoms: nasal discharge (runny nose), nasal congestion, sneezing, and sore throat.
The 84 patients reporting perfect empathy had similar demographics to the rest of the group (n = 266). The severity of their cold symptoms fell faster than the others starting on day 2 and remained lower until resolution of the cold. The perfect empathy group had a mean duration of 7.10 days compared with 8.01 for the others (P = 0.017). The perfect empathy group showed a rise in the IL-8 immune marker more than double the control group, suggesting a much greater immune response to the cold related to empathy (P = 0.015).
Commentary
The lead author and investigator of this study is David Rakel, MD, son of Robert Rakel, MD, legendary author and editor. I know David well and he is a true scholar and serious investigator. Following his family medicine residency, he completed the integrative medicine fellowship program at the University of Arizona and authored a textbook, Integrative Medicine, published by Saunders.3 His research team at the University of Wisconsin is conducting high-quality, evidence-based investigations of integrative medicine.
Psychoneuroimmunology is the study of psychological processes (like empathy) and their impact on both the nervous and immunologic systems.4 Evidence of these connections is vast and this is an emerging area of science. It is the biology of the mind-body connection. The bottom line from this study is that empathy heals, at least for the common cold. We all know that the physician is a therapeutic agent, at least as powerful as any medication. In the busy practice of primary care, taking the time to show empathy is a real challenge.5 Maybe with the new patient-centered medical home models there will be more time for better communication with our patients. Much of the care coordination work in patient care may be done outside of visits, giving us more time to communicate with patients and show empathy.
Empathy is not just the soft side of medical practice. As this randomized controlled trial shows, empathy with patients is associated with better response to sickness and faster healing. The only cost is our time, attention, skill, and caring. That would be real health care reform.
References
1. Mercer SW, Reynolds WJ. Empathy and quality of care. Br J Gen Pract 2002;52(Suppl):S9-S12.
2. Barrett B, et al. The Wisconsin Upper Respiratory Symptom Survey is responsive, reliable, and valid. J Clin Epidemiol 2005;58:609-617.
3. Rakel DP. Integrative Medicine. Philadelphia: Saunders; 2003.
4. Ader R, ed. Psychoneuroimmunology, 4th ed. New York: Academic Press; 2007.
5. Ludmerer KM. Time to Heal. New York: Oxford University Press; 1999.
A randomized controlled trial demonstrated that "perfect" empathy with patients results in a better immune response, reduction of symptoms, and faster recovery from a common cold.Subscribe Now for Access
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