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DOCTOR-PATIENT RELATIONSHIP INFLUENCES HEALTH OUTCOMES

March 07, 2001
Physicians who adopt a warm, friendly, and reassuring manner are more effective than those who keep consultations formal and do not offer reassurance, conclude authors of a systematic review published in this week’s issue of THE LANCET.

Throughout history, doctor–patient relationships have been acknowledged as having an important therapeutic effect – known as a context effect - irrespective of any prescribed drug or treatment. Zelda Di Blasi and colleagues from the University of York, UK, did a systematic review to determine whether there was any empirical evidence to support this theory.

The investigators used various medical, psychological, and sociological databases to identify potential trials for inclusion in the review. Two independent reviewers assessed the quality of the trials. The type of non-treatment care given in each trial was categorised as either cognitive or emotional. Cognitive care aimed to influence patients’ expectations about the illness or the treatment, whereas emotional care referred to the style of the consultation (eg, warm, empathic), and aimed to reduce negative feelings such as anxiety and fear. Emotional and cognitive care were expected to work in an interactive manner, and to enhance the effectiveness of therapy or physical care.

25 eligible randomised controlled trials were identified. 19 examined the effects of influencing patients’ expectations about treatment, half of which reported a positive effect. None of the studies examined the effects of emotional care alone, but four trials assessed a combination of both cognitive and emotional care. Three of these studies showed that enhancing patients’ expectations through positive information about the treatment or the illness, while providing support or reassurance, positively influenced health outcomes.

In an accompanying Commentary (p 733), Chris van Weel from University Medical Centre St Radboud, Nijmegen, Netherlands, states that primary care is the obvious environment for context effects to influence health outcomes. He comments: “…the care is low in technology, rich in personal touch. The continuity of care by one person and over time strengthens the trust between patient and practitioner and enables the doctor to accumulate knowledge of the patient’s personal and family circumstances. Di Blasi and colleagues’ report adds empirical data to these theoretical considerations and emphasises the importance of the labelling of health problems, of clarifying the most likely prognosis, and of offering reassurance, thus presenting a focus for future research in general practice”.

Contact: Ms Zelda Di Blasi; T) +353 21 450 1515; M) +353 (0)879 448192; E) zeldadiblasi@yahoo.com

Professor Chris van Weel, Department of General Practice, University Medical Centre St Radboud, Nijmegen, 6500 HB Nijmegen, Netherlands; T) +31 24 361 6332; F) +31 24 354 1862; E) c.vanweel@hsv.kun.nl




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