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Mohanta A, Sardar N, Chakraborty K, Sarkar M, Saha T, Deb A, Hossain MS, Basu A, Samim S, Bhattacharyya S, Saha S, Basu B, Sen A, Giri M, Debnath P, Saha S, Koley M, Mukherjee SK, Rutten L. Estimation of the Likelihood Ratio of Different Symptoms for Six Homeopathic Medicines: Prognostic Factor Research. HOMEOPATHY 2024. [PMID: 38977002 DOI: 10.1055/s-0044-1787078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
BACKGROUND Arsenicum album, Causticum, Nux vomica, Pulsatilla nigricans, Rhus toxicodendron and Sulphur are frequently prescribed homeopathic medicines; however, their symptoms, as mentioned in different homeopathic literature works, have rarely been investigated systematically. Likelihood ratio (LR), based on Bayesian statistics, may reflect a better estimation of the strengths of symptoms than the existing entries in the homeopathic literature. METHODS A prospective, longitudinal, analytical patient outcome study was conducted in the outpatient departments of D. N. De Homeopathic Medical College and Hospital, Kolkata, on 1,954 patients over 21 months. The outcomes were recorded at each follow-up using the Outcome Related to Impact on Daily Living (ORIDL) +4 to -4 scale. The average period of treatment for each participant was 3 months. The LRs of four symptoms for each of the six selected medicines were calculated. RESULTS One hundred and two different remedies were prescribed. The prevalence, LR + , and LR - , with respective 95% confidence intervals, of different symptoms were reported. The study found that the following symptoms had particularly high LR+ scores: "intense sympathy for the suffering of others" (Causticum, LR+ = 12.0); "dyspepsia from business anxiety" (Nux vomica, LR+ = 27.4); "burning pain relieved by heat" (Arsenicum album, LR+ = 29.6); "envy" (Pulsatilla nigricans, LR+ = 13.2); "desire for milk" (Rhus toxicodendron, LR+ = 7.5); "very selfish, no regard for others" (Sulphur, LR+ = 20.6). The findings corroborated well with the presentation of the symptoms in different homeopathic materia medica and repertories. ORIDL scores of +2 or greater were identified most prominently for Pulsatilla nigricans (n = 138) and Sulphur (n = 119). CONCLUSION There was adequate evidence to attribute all the assessed symptoms to the medicines investigated. Further studies with a larger population are warranted to tackle the possible confirmation bias.
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Affiliation(s)
- Aditi Mohanta
- Department of Materia Medica, D. N. De Homeopathic Medical College and Hospital, Kolkata, West Bengal; affiliated to The West Bengal University of Health Sciences, Government of West Bengal, India
| | - Nipa Sardar
- Department of Materia Medica, D. N. De Homeopathic Medical College and Hospital, Kolkata, West Bengal; affiliated to The West Bengal University of Health Sciences, Government of West Bengal, India
| | - Koli Chakraborty
- Department of Materia Medica, D. N. De Homeopathic Medical College and Hospital, Kolkata, West Bengal; affiliated to The West Bengal University of Health Sciences, Government of West Bengal, India
| | - Malabika Sarkar
- Department of Materia Medica, D. N. De Homeopathic Medical College and Hospital, Kolkata, West Bengal; affiliated to The West Bengal University of Health Sciences, Government of West Bengal, India
| | - Tamoghna Saha
- Department of Materia Medica, D. N. De Homeopathic Medical College and Hospital, Kolkata, West Bengal; affiliated to The West Bengal University of Health Sciences, Government of West Bengal, India
| | - Anuruddha Deb
- Department of Materia Medica, D. N. De Homeopathic Medical College and Hospital, Kolkata, West Bengal; affiliated to The West Bengal University of Health Sciences, Government of West Bengal, India
| | - Md Sakhawat Hossain
- Department of Materia Medica, D. N. De Homeopathic Medical College and Hospital, Kolkata, West Bengal; affiliated to The West Bengal University of Health Sciences, Government of West Bengal, India
| | - Arpita Basu
- Department of Materia Medica, D. N. De Homeopathic Medical College and Hospital, Kolkata, West Bengal; affiliated to The West Bengal University of Health Sciences, Government of West Bengal, India
| | - Saima Samim
- Department of Materia Medica, D. N. De Homeopathic Medical College and Hospital, Kolkata, West Bengal; affiliated to The West Bengal University of Health Sciences, Government of West Bengal, India
| | - Soumya Bhattacharyya
- Department of Materia Medica, D. N. De Homeopathic Medical College and Hospital, Kolkata, West Bengal; affiliated to The West Bengal University of Health Sciences, Government of West Bengal, India
| | - Sangita Saha
- Department of Organon of Medicine and Homeopathic Philosophy, D. N. De Homeopathic Medical College and Hospital, Kolkata, West Bengal; affiliated to The West Bengal University of Health Sciences, Government of West Bengal, India
| | - Biswajit Basu
- Department of Materia Medica, D. N. De Homeopathic Medical College and Hospital, Kolkata, West Bengal; affiliated to The West Bengal University of Health Sciences, Government of West Bengal, India
| | - Anindya Sen
- Department of Materia Medica, D. N. De Homeopathic Medical College and Hospital, Kolkata, West Bengal; affiliated to The West Bengal University of Health Sciences, Government of West Bengal, India
| | - Mohan Giri
- Department of Practice of Medicine, D. N. De Homeopathic Medical College and Hospital, Kolkata, West Bengal; affiliated to The West Bengal University of Health Sciences, Government of West Bengal, India
| | - Pintu Debnath
- Hospital Section, D. N. De Homeopathic Medical College and Hospital, Kolkata, West Bengal; affiliated to The West Bengal University of Health Sciences, Government of West Bengal, India
| | - Subhranil Saha
- Department of Repertory, D. N. De Homeopathic Medical College and Hospital, Kolkata, West Bengal; affiliated to The West Bengal University of Health Sciences, Government of West Bengal, India
| | - Munmun Koley
- Department of Homeopathy, East Bishnupur State Homeopathic Dispensary, Chandi Daulatabad Block Primary Health Centre, South 24 Parganas, West Bengal, under Department of Health and Family Welfare, Government of West Bengal, India
| | - Shyamal Kumar Mukherjee
- Department of Community Medicine, D. N. De Homeopathic Medical College and Hospital, Kolkata, West Bengal; affiliated to The West Bengal University of Health Sciences, Government of West Bengal, India
| | - Lex Rutten
- VHAN, Dutch Association of Homeopathic Physicians, Breda, The Netherlands
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Brar SS, G R, Joshi A, Rozatkar AR, Bajaj E, Pakhare AP. Empathy Among Medical Students: An Exploratory Cross-Sectional Survey. Cureus 2024; 16:e60166. [PMID: 38868271 PMCID: PMC11167132 DOI: 10.7759/cureus.60166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2024] [Indexed: 06/14/2024] Open
Abstract
Context In the context of healthcare, effective communication and empathy are fundamental skills for physicians, as empathy correlates positively with patient satisfaction, compliance, treatment adherence, and lower rates of physician burnout, depression and anxiety. This study aimed to assess empathy levels and related factors among undergraduate medical students. Methods A cross-sectional study in a Central Indian medical institute examined empathy levels and factors associated with it among medical students, utilizing various scales and statistical analyses. Results This study found that while empathy levels were relatively high among undergraduate students, there was a decline as they progressed through medical education, particularly after the first year of clinical exposure. The study identified several factors associated with empathy levels, including perceived stress, emotional separation, and social support. Notably, individuals experiencing higher levels of stress and emotional separation tended to have higher empathy levels. Conclusions The study's findings suggest that medical education should incorporate interventions to enhance empathy, including addressing stress, providing social support, and exposing students to the emotional aspects of patient care.
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Affiliation(s)
- Sukhmanjit S Brar
- Community & Family Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Revadi G
- Community & Family Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Ankur Joshi
- Community & Family Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Abhijit R Rozatkar
- Department of Psychiatry, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Ehsaas Bajaj
- Community & Family Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Abhijit P Pakhare
- Community & Family Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
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Pourmand A, Shapovalov V, Manfredi RA, Potenza MA, Roche C, Shesser R. ED WAIT: A communication model for addressing difficult patient encounters in the emergency department. Am J Emerg Med 2024; 77:211-214. [PMID: 38212209 DOI: 10.1016/j.ajem.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/02/2024] [Accepted: 01/06/2024] [Indexed: 01/13/2024] Open
Affiliation(s)
- Ali Pourmand
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States.
| | - Vadym Shapovalov
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Rita A Manfredi
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States; Geriatrics and Palliative Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Marissa A Potenza
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Colleen Roche
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Robert Shesser
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
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Murry LT, Reist JC, Fravel MA, Knockel LE, Witry MJ. An Exploratory Mixed Methods Study of Standardized Patient Comments on Empathy and Student Communication Scores. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2022; 86:ajpe8642. [PMID: 34301573 PMCID: PMC8887057 DOI: 10.5688/ajpe8642] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/15/2021] [Indexed: 06/13/2023]
Abstract
Objective. To quantify student pharmacists' communication ability based on scores from standardized patient (SP) communication rubrics, describe and categorize SP comments about student empathy, and test the relationship between students' communication scores and empathy.Methods. A concurrent mixed methods research design was used to assess a graded performance-based assessment (PBA) of student pharmacists that had been conducted at one college of pharmacy. The PBA rubrics (n=218) completed by SPs contained 20 assessment items and space for open-ended feedback. Scoring categories for communication assessment included: yes, inconsistent, no, and not applicable (N/A). Descriptive statistics were calculated for rubric scores. Feedback from standardized patients was analyzed and used to categorize student interactions during the encounter as reflecting high empathy, mixed empathy, or low empathy. Kruskal-Wallis ANOVA was used to test the relationship between empathy category and communication score.Results. Standardized patients had written comments on 141 of the 218 rubrics (64.7%). The mean communication score was 39.0±1.6 (range, 31-40) out of a maximum 40 points. The total scores for the low, mixed, and high empathy category transformations were 6 (4.3%), 95 (67.4%), and 40 (28.4%), respectively. The results of the Kruskal-Wallis ANOVA were significant, suggesting that communication scores were different between empathy categories.Conclusion. There was a positive association between students' scores on communication rubrics and student empathy categorization, with student pharmacists exhibiting different levels of clinical empathy. While the PBA of interest was not specifically focused on empathy, SPs frequently provided feedback about empathy to students, suggesting that showing empathy during the encounter was important.
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Affiliation(s)
- Logan T Murry
- The University of Iowa, College of Pharmacy, Iowa City, Iowa
| | - Jeffrey C Reist
- The University of Iowa, College of Pharmacy, Iowa City, Iowa
| | | | - Laura E Knockel
- The University of Iowa, College of Pharmacy, Iowa City, Iowa
| | - Mathew J Witry
- The University of Iowa, College of Pharmacy, Iowa City, Iowa
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Guidi C, Traversa C. Empathy in patient care: from 'Clinical Empathy' to 'Empathic Concern'. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2021; 24:573-585. [PMID: 34196934 PMCID: PMC8557158 DOI: 10.1007/s11019-021-10033-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/20/2021] [Indexed: 06/07/2023]
Abstract
As empathy gains importance within academia, we propose this review as an attempt to bring clarity upon the diverse and widely debated definitions and conceptions of empathy within the medical field. In this paper, we first evaluate the limits of the Western mainstream medical culture and discuss the origins of phenomena such as dehumanization and detached concern as well as their impacts on patient care. We then pass on to a structured overview of the debate surrounding the notion of clinical empathy and its taxonomy in the medical setting. In particular, we present the dichotomous conception of clinical empathy that is articulated in the debate around cognitive empathy and affective empathy. We thus consider the negative impacts that this categorization brings about. Finally, we advocate for a more encompassing, holistic conception of clinical empathy; one that gives value to a genuine interest in welcoming, acknowledging and responding to the emotions of those suffering. Following this line of reasoning, we advance the notion of 'empathic concern', a re-conceptualization of clinical empathy that finds its source in Halpern in Med Health Care Philos (2014) 17:301-311 engaged curiosity. We ultimately advance Narrative Medicine as an approach to introduce, teach and promote such an attitude among medical trainees and practitioners.
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Bedford LE, Yeung MHY, Au CH, Tse ETY, Yim WY, Yu EYT, Wong CKH, Lam CLK. The validity, reliability, sensitivity and responsiveness of a modified Patient Enablement Instrument (PEI-2) as a tool for serial measurements of health enablement. Fam Pract 2021; 38:339-345. [PMID: 32968812 PMCID: PMC8414911 DOI: 10.1093/fampra/cmaa102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Patient enablement is a core tenet of patient-centred and holistic primary care. The Patient Enablement Instrument (PEI) is a transitional measure limited in its ability to measure changes over time. A modified version, PEI-2, has been developed to measure enablement at a given time-point without comparison to a recalled baseline. OBJECTIVE To assess the validity, reliability, sensitivity and responsiveness of PEI-2. METHODS PEI-2 was modified from the Chinese PEI to assess enablement over 4 weeks in a prospective cohort study nested within a community support programme [Trekkers Family Enhancement Scheme (TFES)] in Hong Kong. Construct validity was assessed by factor analysis and convergent validity by Spearman's correlations with health-related quality of life and depressive symptoms. Internal reliability was assessed using Cronbach's alpha. Test-retest reliability was assessed by intraclass correlation (ICC), responsiveness by 12-24-month change in PEI-2 score and sensitivity by differences in change of PEI-2 score between TFES participants and a control group. RESULTS PEI-2 demonstrated construct validity with all items loading on one factor (factor loadings >0.7). Convergent validity was confirmed by significant correlations with 12-item Short Form Questionnaire, version 2 (r = 0.1089-0.1919) and Patient Health Questionnaire-9 (r = -0.2030). Internal reliability was high (Cronbach's alpha = 0.9095) and test-retest reliability moderate (ICC = 0.520, P = 0.506). Significant improvements in PEI-2 scores among the TFES group suggested good responsiveness (P < 0.001). The difference in change of PEI-2 scores between TFES and control was significant (P = 0.008), indicating good sensitivity. CONCLUSIONS This study supports the validity, reliability, sensitivity and responsiveness of PEI-2 in measuring changes in enablement, making it a promising tool for evaluating enablement in cohort and intervention studies.
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Affiliation(s)
- Laura Elizabeth Bedford
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
| | - Maegan Hon Yan Yeung
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
| | - Chi Ho Au
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
| | - Emily Tsui Yee Tse
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
| | - Wing Yee Yim
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
| | - Esther Yee Tak Yu
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
| | - Carlos King Ho Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China.,Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
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Manchanda R, Rutten L, Dogra A, Chakraborty P, Misra A, Chakma A, Prasad VG, Singh P, Kundu C, Koley M, Saha S. Psychometric validation of the modified Naranjo algorithm used in homeopathy for chronic cases. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2021; 19:101-109. [PMID: 33964193 DOI: 10.1515/jcim-2020-0434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 01/05/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The modified Naranjo algorithm assesses the physician assigned cause-effect relationship for homeopathic medicines. It is being adopted in homeopathy researches, but not yet validated systematically. We intended to validate the modified Naranjo algorithm by examining its psychometric properties. METHODS An online survey sought agreement of 25 experts on the 10 items of the tool on 5-point agreement scale. Next, 285 responses from collected prospectively from chronic cases enrolled under the clinical verification program of the council in 2018 were subjected to testing of construct validity using exploratory principal component analysis (PCA). Confirmatory factor analysis (CFA; n=150) was performed to verify the goodness-of-fit of the model. Reliability was tested using internal consistency, test-retest reliability, and inter-rater reliability by kappa statistics. RESULTS Experts' responses mean values were 4 or higher (i.e. responses were relevant) and standard deviations were less than 1 (i.e. less heterogeneous). In PCA using varimax, all the items loaded above the pre-specified value of 0.4 and identified 4 components explaining 64.1% of variation. The goodness-of -fit of the 4-component CFA model was acceptable (chi-square 89.253, p<0.001). Internal consistency (Cronbach's alpha 0.7) was borderline; test-retest reliability was acceptable. Kappa statistics was moderate to fair, but poor for few of the items. CONCLUSIONS Statistical evaluations indicate that the modified Naranjo algorithm is useful, but needs improvement.
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Affiliation(s)
- Rajkumar Manchanda
- AYUSH, Govt. of NCT of Delhi, New Delhi, India.,Information and Communication, Liga Medicorum Homoeopathica Internationalis (LMHI), Köthen, Germany.,Central Council for Research in Homoeopathy, Ministry of AYUSH, Govt. of India, New Delhi, India
| | - Lex Rutten
- VHAN, Dutch Association of Homeopathic Physicians, Breda, The Netherlands
| | - Atanu Dogra
- Dept. of Psychology, University of Calcutta, Kolkata, West Bengal, India
| | - Parthasarathi Chakraborty
- Dr. Anjali Chatterjee Regional Research Institute of Homoeopathy, Under Central Council for Research in Homoeopathy, Ministry of AYUSH, Govt. of India, Kolkata, India
| | - Alok Misra
- Dr. Anjali Chatterjee Regional Research Institute of Homoeopathy, Under Central Council for Research in Homoeopathy, Ministry of AYUSH, Govt. of India, Kolkata, India.,Dept. of Organon of Medicine and Homoeopathic Philosophy, Mahesh Bhattacharyya Homoeopathic Medical College and Hospital, Govt. of West Bengal, Howrah, India
| | - Abhijit Chakma
- Regional Research Institute (H), Under Central Council for Research in Homoeopathy, Ministry of AYUSH, Govt. of India, Agartala, India
| | - Varanasi Gayatri Prasad
- Regional Research Institute for Homoeopathy, Under Central Council for Research in Homoeopathy, Ministry of AYUSH, Govt. of India, Gudivada, India
| | - Pramodji Singh
- Central Research Institute (Homoeopathy), Under Central Council for Research in Homoeopathy, Ministry of AYUSH, Govt. of India, Noida, Uttar Pradesh, India
| | - Chittaranjan Kundu
- Dr. Anjali Chatterjee Regional Research Institute of Homoeopathy, Under Central Council for Research in Homoeopathy, Ministry of AYUSH, Govt. of India, Kolkata, India
| | - Munmun Koley
- Dr. Anjali Chatterjee Regional Research Institute of Homoeopathy, Under Central Council for Research in Homoeopathy, Ministry of AYUSH, Govt. of India, Kolkata, India.,Dept. of Organon of Medicine and Homoeopathic Philosophy, State National Homoeopathic Medical College and Hospital, Govt. of Uttar Pradesh, Lucknow, India
| | - Subhranil Saha
- Dept. of Repertory, D. N. De Homoeopathic Medical College and Hospital, Govt. of West Bengal, Kolkata, India.,Homoeopathy Drug Research Institute, Central Council for Research in Homoeopathy, Ministry of AYUSH, Govt. of India, Lucknow, India
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Dambha-Miller H, Day A, Kinmonth AL, Griffin SJ. Primary care experience and remission of type 2 diabetes: a population-based prospective cohort study. Fam Pract 2021; 38:141-146. [PMID: 32918549 PMCID: PMC8006762 DOI: 10.1093/fampra/cmaa086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Remission of Type 2 diabetes is achievable through dietary change and weight loss. In the UK, lifestyle advice and referrals to weight loss programmes predominantly occur in primary care where most Type 2 diabetes is managed. OBJECTIVE To quantify the association between primary care experience and remission of Type 2 diabetes over 5-year follow-up. METHODS A prospective cohort study of adults with Type 2 diabetes registered to 49 general practices in the East of England, UK. Participants were followed-up for 5 years and completed the Consultation and Relational Empathy measure (CARE) on diabetes-specific primary care experiences over the first year after diagnosis of the disease. Remission at 5-year follow-up was measured with HbA1c levels. Univariable and multivariable logistic regression models were constructed to quantify the association between primary care experience and remission of diabetes. RESULTS Of 867 participants, 30% (257) achieved remission of Type 2 diabetes at 5 years. Six hundred twenty-eight had complete data at follow-up and were included in the analysis. Participants who reported higher CARE scores in the 12 months following diagnosis were more likely to achieve remission at 5 years in multivariable models; odds ratio = 1.03 (95% confidence interval = 1.01-1.05, P = 0.01). CONCLUSION Primary care practitioners should pay greater attention to delivering optimal patient experiences alongside clinical management of the disease as this may contribute towards remission of Type 2 diabetes. Further work is needed to examine which aspects of the primary care experience might be optimized and how these could be operationalized.
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Affiliation(s)
- Hajira Dambha-Miller
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.,MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.,Division of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Alexander Day
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Ann Louise Kinmonth
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Simon J Griffin
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.,MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
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Roberts BW, Puri NK, Trzeciak CJ, Mazzarelli AJ, Trzeciak S. Socioeconomic, racial and ethnic differences in patient experience of clinician empathy: Results of a systematic review and meta-analysis. PLoS One 2021; 16:e0247259. [PMID: 33657153 PMCID: PMC7928470 DOI: 10.1371/journal.pone.0247259] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 02/03/2021] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Empathy is essential for high quality health care. Health care disparities may reflect a systemic lack of empathy for disadvantaged people; however, few data exist on disparities in patient experience of empathy during face-to-face health care encounters with individual clinicians. We systematically analyzed the literature to test if socioeconomic status (SES) and race/ethnicity disparities exist in patient-reported experience of clinician empathy. METHODS Using a published protocol, we searched Ovid MEDLINE, PubMed, CINAHL, EMBASE, CENTRAL and PsychINFO for studies using the Consultation and Relational Empathy (CARE) Measure, which to date is the most commonly used and well-validated methodology for measuring clinician empathy from the patient perspective. We included studies containing CARE Measure data stratified by SES and/or race/ethnicity. We contacted authors to request stratified data, when necessary. We performed quantitative meta-analyses using random effects models to test for empathy differences by SES and race/ethnicity. RESULTS Eighteen studies (n = 9,708 patients) were included. We found that, compared to patients whose SES was not low, low SES patients experienced lower empathy from clinicians (mean difference = -0.87 [95% confidence interval -1.72 to -0.02]). Compared to white patients, empathy scores were numerically lower for patients of multiple race/ethnicity groups (Black/African American, Asian, Native American, and all non-whites combined) but none of these differences reached statistical significance. CONCLUSION These data suggest an empathy gap may exist for patients with low SES. More research is needed to further test for SES and race/ethnicity disparities in clinician empathy and help promote health care equity. TRIAL REGISTRATION Registration (PROSPERO): CRD42019142809.
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Affiliation(s)
- Brian W. Roberts
- Cooper University Health Care, Camden, New Jersey, United States of America
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
- Center for Humanism, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
| | - Nitin K. Puri
- Cooper University Health Care, Camden, New Jersey, United States of America
- Department of Medicine, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
| | | | - Anthony J. Mazzarelli
- Cooper University Health Care, Camden, New Jersey, United States of America
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
- Center for Humanism, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
| | - Stephen Trzeciak
- Cooper University Health Care, Camden, New Jersey, United States of America
- Center for Humanism, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
- Department of Medicine, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
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Bagacean C, Cousin I, Ubertini AH, El Yacoubi El Idrissi M, Bordron A, Mercadie L, Garcia LC, Ianotto JC, De Vries P, Berthou C. Simulated patient and role play methodologies for communication skills and empathy training of undergraduate medical students. BMC MEDICAL EDUCATION 2020; 20:491. [PMID: 33276777 PMCID: PMC7716460 DOI: 10.1186/s12909-020-02401-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 11/24/2020] [Indexed: 05/06/2023]
Abstract
BACKGROUND Verbal and non-verbal communication, as well as empathy are central to patient-doctor interactions and have been associated with patients' satisfaction. Non-verbal communication tends to override verbal messages. The aim of this study was to analyze how medical students use verbal and non-verbal communication using two different educational approaches, student role play (SRP) and actor simulated patient (ASP), and whether the non-verbal behaviour is different in the two different poses. METHODS Three raters evaluated 20 students playing the doctor role, 10 in the SRP group and 10 in the ASP group. The videos were analyzed with the Calgary-Cambridge Referenced Observation Guide (CCG) and, for a more accurate evaluation of non-verbal communication, we also evaluated signs of nervousness, and posture. Empathy was rated with the CARE questionnaire. Independent Mann Whitney U tests and Qhi square tests were performed for statistical analysis. RESULTS From the 6 main tasks of the CCG score, we obtained higher scores in the ASP group for the task 'Gathering information' (p = 0.0008). Concerning the 17 descriptors of the CCG, the ASP group obtained significantly better scores for 'Exploration of the patients' problems to discover the biomedical perspective' (p = 0.007), 'Exploration of the patients' problems to discover background information and context' (p = 0.0004) and for 'Closing the session - Forward planning' (p = 0.02). With respect to non-verbal behaviour items, nervousness was significantly higher in the ASP group compared to the SRP group (p < 0.0001). Concerning empathy, no differences were found between the SRP and ASP groups. CONCLUSIONS Medical students displayed differentiated verbal and non-verbal communication behaviour during the two communication skills training methodologies. These results show that both methodologies have certain advantages and that more explicit non-verbal communication training might be necessary in order to raise students' awareness for this type of communication and increase doctor-patient interaction effectiveness.
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Affiliation(s)
- Cristina Bagacean
- Univ Brest, Inserm, UMR1227, Lymphocytes B et Autoimmunité, Brest, France
- Department of Clinical Hematology, CHU de Brest, Brest University Medical School Hospital, 2 Av Foch, 29609 Brest, France
| | - Ianis Cousin
- Department of Pediatric Surgery, CHU de Brest, Brest, France
| | | | - Mohamed El Yacoubi El Idrissi
- Department of Clinical Hematology, CHU de Brest, Brest University Medical School Hospital, 2 Av Foch, 29609 Brest, France
| | - Anne Bordron
- Univ Brest, Inserm, UMR1227, Lymphocytes B et Autoimmunité, Brest, France
| | - Lolita Mercadie
- Univ Brest, Department of Humanities and Social Sciences (SHS), Brest, France
| | | | - Jean-Christophe Ianotto
- Department of Clinical Hematology, CHU de Brest, Brest University Medical School Hospital, 2 Av Foch, 29609 Brest, France
| | | | - Christian Berthou
- Univ Brest, Inserm, UMR1227, Lymphocytes B et Autoimmunité, Brest, France
- Department of Clinical Hematology, CHU de Brest, Brest University Medical School Hospital, 2 Av Foch, 29609 Brest, France
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Tolvanen E, Koskela TH, Helminen M, Kosunen E. The validity and reliability of the patient enablement instrument (PEI) after GP appointments in Finnish health care centres. J Patient Rep Outcomes 2020; 4:79. [PMID: 32936378 PMCID: PMC7494691 DOI: 10.1186/s41687-020-00243-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 08/25/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The aim of this study was to assess the validity and reliability of the Patient Enablement Instrument (PEI) in Finnish health care centre patients. A pilot study was conducted to assess the content validity of the PEI. A questionnaire study in three health care centres in Western Finland was performed in order to assess acceptability, construct validity, internal consistency, and measurement error of the instrument. A telephone interview 2 weeks after the appointment was performed to evaluate reproducibility. RESULTS The pilot study with 17 participants indicated good content validity of the PEI. In the questionnaire study, altogether 483 with a completed PEI score were included in the analyses. Factor analysis and item-scale correlations suggested high structural validity. The internal consistency of the instrument was high (Cronbach's α = 0.93). The PEI score diminished strongly over the two-week period. CONCLUSIONS The PEI has good content validity and acceptability, good construct validity, high internal consistency but low reproducibility. Thus, the PEI seems to be an applicable tool to measure patient enablement in Finnish primary health care.
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Affiliation(s)
- Elina Tolvanen
- Faculty of Medicine and Health Technology, Tampere University, c/o coordinator Leena Kiuru, Arvo Building B, 33014, Tampere, Finland. .,Pirkkala Municipal Health Centre, Pirkkala, Finland. .,Research, Development and Innovation Centre, Tampere University Hospital, Tampere, Finland.
| | - Tuomas H Koskela
- Faculty of Medicine and Health Technology, Tampere University, c/o coordinator Leena Kiuru, Arvo Building B, 33014, Tampere, Finland
| | - Mika Helminen
- Research, Development and Innovation Centre, Tampere University Hospital, Tampere, Finland.,Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland
| | - Elise Kosunen
- Faculty of Medicine and Health Technology, Tampere University, c/o coordinator Leena Kiuru, Arvo Building B, 33014, Tampere, Finland.,Centre for General Practice, Pirkanmaa Hospital District, Tampere, Finland
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Tolvanen E, Groenewegen PP, Koskela TH, Bjerve Eide T, Cohidon C, Kosunen E. Patient enablement after a consultation with a general practitioner-Explaining variation between countries, practices and patients. Health Expect 2020; 23:1129-1143. [PMID: 32602205 PMCID: PMC7696125 DOI: 10.1111/hex.13091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/08/2020] [Accepted: 05/22/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Patient enablement is a concept developed to measure quality in primary health care. The comparative analysis of patient enablement in an international context is lacking. OBJECTIVE To explain variation in patient enablement between patients, general practitioners (GPs) and countries. To find independent variables associated with enablement. DESIGN We constructed multi-level logistic regression models encompassing variables from patient, GP and country levels. The proportions of explained variances at each level and odds ratios for independent variables were calculated. SETTING AND PARTICIPANTS A total of 7210 GPs and 58 930 patients in 31 countries were recruited through the Quality and Costs of Primary Care in Europe (QUALICOPC) study framework. In addition, data from the Primary Health Care Activity Monitor for Europe (PHAMEU) study and Hofstede's national cultural dimensions were combined with QUALICOPC data. RESULTS In the final model, 50.6% of the country variance and 18.4% of the practice variance could be explained. Cultural dimensions explained a major part of the variation between countries. Several patient-level and only a few practice-level variables showed statistically significant associations with patient enablement. Structural elements of the relevant health-care system showed no associations. From the 20 study hypotheses, eight were supported and four were partly supported. DISCUSSION AND CONCLUSIONS There are large differences in patient enablement between GPs and countries. Patient characteristics and patients' perceptions of consultation seem to have the strongest associations with patient enablement. When comparing patient-reported measures as an indicator of health-care system performance, researchers should be aware of the influence of cultural elements.
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Affiliation(s)
- Elina Tolvanen
- Faculty of Medicine and Health Technology, c/o coordinator Leena Kiuru, Tampere University, Tampere, Finland.,Pirkkala Municipal Health Centre, Pirkkala, Finland.,Science Centre, Pirkanmaa Hospital District, Tampere, Finland
| | - Peter P Groenewegen
- Nivel-Netherlands Institute for Health Services Research, Utrecht, The Netherlands.,Department of Sociology, Utrecht University, Utrecht, The Netherlands.,Department of Human Geography, Utrecht University, Utrecht, The Netherlands
| | - Tuomas H Koskela
- Faculty of Medicine and Health Technology, c/o coordinator Leena Kiuru, Tampere University, Tampere, Finland
| | - Torunn Bjerve Eide
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Christine Cohidon
- Department of Family Medicine, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Elise Kosunen
- Faculty of Medicine and Health Technology, c/o coordinator Leena Kiuru, Tampere University, Tampere, Finland.,Centre for General Practice, Pirkanmaa Hospital District, Tampere, Finland
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Yu J, Lee S, Kim M, Lim K, Chang K, Lee M. Relationships Between Perspective-Taking, Empathic Concern, and Self-rating of Empathy as a Physician Among Medical Students. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2020; 44:316-319. [PMID: 31873921 PMCID: PMC7237518 DOI: 10.1007/s40596-019-01114-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 08/21/2019] [Accepted: 08/29/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The aim of this study was to ascertain the relationships between perspective-taking, empathic concern, and self-rating of empathy as a physician among medical students. METHODS This study analyzed the questionnaire responses of 152 medical students enrolled in Ajou University School of Medicine, Suwon, Republic of Korea, in 2018. As measurement instruments, the authors applied the Interpersonal Reactivity Index (IRI) and Korean Student Version of the Jefferson Scale of Physician Empathy (Korean JSPE-S), and then examined participant characteristic variables based on the obtained data and conducted subsequent correlation analyses of subscales, one-way ANOVA, and regression analyses. RESULTS Medical students with clinical clerkship experience demonstrated higher levels of perspective-taking and empathy as physicians than did students without experience. Moreover, perspective-taking and empathic concern were significant predictors of medical students' empathy as physicians in the regression model. CONCLUSIONS Medical students with higher scores in perspective-taking and empathic concern demonstrated higher levels of perception regarding the necessity and importance of empathy as a physician in patient-physician relationships. Therefore, in actual medical situations with patient-centered therapy, to enhance the levels of physician empathy, medical education should focus on the understanding of other persons' opinions and interpersonal interactions accompanied by empathic concern.
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Affiliation(s)
- Jihye Yu
- Ajou University School of Medicine and Graduate School of Medicine, Suwon, Gyeonggi-do, South Korea
| | - Sukyung Lee
- Ajou University School of Medicine and Graduate School of Medicine, Suwon, Gyeonggi-do, South Korea
| | - Miran Kim
- Ajou University School of Medicine and Graduate School of Medicine, Suwon, Gyeonggi-do, South Korea.
| | - Kiyoung Lim
- Ajou University School of Medicine and Graduate School of Medicine, Suwon, Gyeonggi-do, South Korea
| | - Kihong Chang
- Ajou University School of Medicine and Graduate School of Medicine, Suwon, Gyeonggi-do, South Korea
| | - Mijin Lee
- Ajou University School of Medicine and Graduate School of Medicine, Suwon, Gyeonggi-do, South Korea
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Dambha-Miller H, Feldman AL, Kinmonth AL, Griffin SJ. Association Between Primary Care Practitioner Empathy and Risk of Cardiovascular Events and All-Cause Mortality Among Patients With Type 2 Diabetes: A Population-Based Prospective Cohort Study. Ann Fam Med 2019; 17:311-318. [PMID: 31285208 PMCID: PMC6827646 DOI: 10.1370/afm.2421] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 02/12/2019] [Accepted: 03/27/2019] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To examine the association between primary care practitioner (physician and nurse) empathy and incidence of cardiovascular disease (CVD) events and all-cause mortality among patients with type 2 diabetes. METHODS This was a population-based prospective cohort study of 49 general practices in East Anglia (United Kingdom). The study population included 867 individuals with screen-detected type 2 diabetes who were followed up for an average of 10 years until December 31, 2014 in the Anglo-Danish-Dutch Study of Intensive Treatment in People With Screen Detected Diabetes in Primary Care (ADDITION)-Cambridge trial. Twelve months after diagnosis, patients assessed practitioner empathy and their experiences of diabetes care during the preceding year using the consultation and relational empathy (CARE) measure questionnaire. CARE scores were grouped into tertiles. The main outcome measures were first recorded CVD event (a composite of myocardial infarction, revascularization, nontraumatic amputation, stroke, and fatal CVD event) and all-cause mortality, obtained from electronic searches of the general practitioner record, national registries, and hospital records. Hazard ratios (HRs) were estimated using Cox models adjusted for relevant confounders. The ADDITION-Cambridge trial is registered as ISRCTN86769081. RESULTS Of the 628 participants with a completed CARE score, 120 (19%) experienced a CVD event, and 132 (21%) died during follow up. In the multivariable model, compared with the lowest tertile, higher empathy scores were associated with a lower risk of CVD events (although this did not achieve statistical significance) and a lower risk of all-cause mortality (HRs for the middle and highest tertiles, respectively: 0.49; 95% CI, 0.27-0.88, P = .01 and 0.60; 95% CI, 0.35-1.04, P = .05). CONCLUSIONS Positive patient experiences of practitioner empathy in the year after diagnosis of type 2 diabetes may be associated with beneficial long-term clinical outcomes. Further work is needed to understand which aspects of patient perceptions of empathy might influence health outcomes and how to incorporate this understanding into the education and training of practitioners.
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Affiliation(s)
- Hajira Dambha-Miller
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- Nuffield Department of Primary Care Health, University of Oxford, Oxford, United Kingdom
| | - Adina L Feldman
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Ann Louise Kinmonth
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Simon J Griffin
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
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Acquati A, Uberti S, Aquino A, Cerasetti E, Castagna C, Rovere-Querini P, Pisa V. Do empathic osteopaths achieve better clinical results? An observational feasibility study. INT J OSTEOPATH MED 2019. [DOI: 10.1016/j.ijosm.2019.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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16
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Vuillemin Q, Schwartzbrod PE, Pasquier P, Sibille F, Trousselard M, Ferrer MH. Influence of Personality Traits on the Effective Performance of Lifesaving Interventions: Example of the Tourniquet Application in Forward Combat Casualty Care. Mil Med 2019; 183:e95-e103. [PMID: 29401335 DOI: 10.1093/milmed/usx011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 10/18/2017] [Indexed: 11/14/2022] Open
Abstract
Introduction Health care delivery in military conflicts implies high-stress environments. Hemorrhage is the first cause of survivable death among combat casualties, and tourniquet application is one of the most critical lifesaving interventions on the battlefield. However, previous studies have shown high failure rates in tourniquet application. Our study aimed to assess the correlation between personality traits that may interfere with effective tourniquet application in a simulated extremity hemorrhage. Materials Seventy-two French soldiers, previously trained to forward combat casualty care, were evaluated by self-administered questionnaires and submitted to the simulation in group of six. We focused on measuring the empathic personality of the subjects, their peer-to-peer relationships (altruism), as well as their relationship to themselves (mindfulness and self-esteem). The effectiveness of the tourniquet was evidenced by the interruption of the popliteal artery flow Doppler signal. A composite variable called "efficiency" was defined by elimination of popliteal pulse Doppler signal in less than 60 s. Results Tourniquet application interrupted arterial flow in 37 participants (51.39%). Efficiency was obtained by 19 participants (26.39%). We observed that soldiers with high active altruism applied less-efficient tourniquet (odds ratio = 0.15; 95% confidence interval = 0.04-0.59). On the contrary, soldiers with high self-esteem scores applied more efficient tourniquet (odds ratio = 3.95; 95% confidence interval = 1.24-12.56). There was no significant difference concerning empathy and mindfulness scores. Conclusion Tourniquet application is technically simple but painful and may involve personal sensitivity. These initial findings highlight the necessity to further explore the psychological processes involved in lifesaving interventions. Self-esteem stands out as a real asset in terms of military competence and resilience, a major prerequisite in stressful situations. Changing altruistic motivations of soldiers is likely not desirable, but being aware of its potential effects may help to develop personal adaptive strategies and to optimize collective training.
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Affiliation(s)
- Quentin Vuillemin
- Legouest Military Hospital, 27 avenue de Plantières, 57077 Metz, France
| | | | - Pierre Pasquier
- Department of Anesthesiology and Intensive Care, Percy Military Hospital, 101 Avenue Henri Barbusse, 92141 Clamart, France
| | - Florian Sibille
- Besançon Military Medical Center, Quartier Joffre, 25009 Besançon, France
| | - Marion Trousselard
- Neurophysiology of Stress Unit, Neuroscience and Operational Constraint Department, French Armed Forces Biomedical Research Institute-IRBA, 1 place Valérie André, 91223 Brétigny-sur-Orge, France
| | - Marie-Hélène Ferrer
- Neurophysiology of Stress Unit, Neuroscience and Operational Constraint Department, French Armed Forces Biomedical Research Institute-IRBA, 1 place Valérie André, 91223 Brétigny-sur-Orge, France
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[Clinical empathy among family and community medicine residents and tutors. The view of physicians and patients]. Aten Primaria 2018; 52:185-192. [PMID: 30522783 PMCID: PMC7063160 DOI: 10.1016/j.aprim.2018.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 04/16/2018] [Accepted: 04/26/2018] [Indexed: 12/30/2022] Open
Abstract
Objetivo Determinar el grado de empatía de residentes y tutores de medicina de familia. Saber si existe relación entre la empatía autopercibida por los médicos y la valorada por sus pacientes. Diseño Estudio observacional transversal mediante encuesta. Emplazamiento Unidad Docente de Atención Primaria, Madrid. Participantes Se envió una encuesta por correo electrónico a todos los tutores y residentes de familia de la Unidad Docente. Respondieron 50 residentes (39,4%) y 41 tutores (45%). Un total de 428 pacientes fueron captados de forma oportunista en un Centro de Salud. Se entrevistó a sus médicos. Mediciones principales La empatía se midió mediante la Escala de Empatía Médica de Jefferson y la Escala de Percepciones de los Pacientes sobre la Empatía Médica de Jefferson. Resultados Los tutores puntuaron 2,53 puntos más alto en empatía cognitiva que los residentes (p = 0,04). Las puntuaciones de la empatía emocional de los tutores son menores en aquellos de mayor edad (r = −0,32; p < 0,05). Los residentes españoles (el 82%) y sin experiencia laboral previa puntuaron más alto en empatía global (p = 0,02). Los residentes de último año obtuvieron calificaciones significativamente más bajas en empatía que el resto de sus compañeros. Se observó correlación positiva (r = 0,72; p = 0,01) entre la autopercepción de la empatía del profesional y la referida por sus pacientes. Conclusiones Los residentes con experiencia profesional previa, los de último año de residencia y los de origen latinoamericano presentan puntuaciones más bajas de empatía. Existe fuerte relación entre la empatía autopercibida por los médicos y la visión que sus pacientes tienen sobre la misma.
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Vogel D, Meyer M, Harendza S. Verbal and non-verbal communication skills including empathy during history taking of undergraduate medical students. BMC MEDICAL EDUCATION 2018; 18:157. [PMID: 29970069 PMCID: PMC6029273 DOI: 10.1186/s12909-018-1260-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 06/18/2018] [Indexed: 05/17/2023]
Abstract
BACKGROUND Verbal and non-verbal aspects of communication as well as empathy are known to have an important impact on the medical encounter. The aim of the study was to analyze how well final year undergraduate medical students use skills of verbal and non-verbal communication during history-taking and whether these aspects of communication correlate with empathy and gender. METHODS During a three steps performance assessment simulating the first day of a resident 30 medical final year students took histories of five simulated patients resulting in 150 videos of physician-patient encounters. These videos were analyzed by external rating with a newly developed observation scale for the verbal and non-verbal communication and with the validated CARE-questionnaire for empathy. One-way ANOVA, t-tests and bivariate correlations were used for statistical analyses. RESULTS Female students showed signicantly higher scores for verbal communication in the case of a female patient with abdominal pain (p < 0.05), while male students started the conversations significantly more often with an open question (p < 0.05) and interrupted the patients significantly later in two cases than female students (p < 0.05). The number of W-questions asked by all students was significantly higher in the case of the female patient with abdominal pain (p < 0.05) and this patient was interrupted after the beginning of the interview significantly earlier than the patients in the other four cases (p < 0.001). Female students reached significantly higher scores for non-verbal communication in two cases (p < 0.05) and showed significantly more empathy than male students in the case of the female patient with abdominal pain (p < 0.05). In general, non-verbal communication correlated significantly with verbal communication and with empathy while verbal communication showed no significant correlation with empathy. CONCLUSIONS Undergraduate medical students display differentiated communication behaviour with respect to verbal and non-verbal aspects of communication and empathy in a performance assessment and special differences could be detected between male and female students. These results suggest that explicit communication training and feedback might be necessary to raise students' awareness for the different aspects of communication and their interaction.
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Affiliation(s)
- Daniela Vogel
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Universitätsklinikum Hamburg-Eppendorf III. Medizinische Klinik Martinistr. 52, D-20246 Hamburg, Germany
| | - Marco Meyer
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Universitätsklinikum Hamburg-Eppendorf III. Medizinische Klinik Martinistr. 52, D-20246 Hamburg, Germany
| | - Sigrid Harendza
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Universitätsklinikum Hamburg-Eppendorf III. Medizinische Klinik Martinistr. 52, D-20246 Hamburg, Germany
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Kootstra TJM, Wilkens SC, Menendez ME, Ring D. Is Physician Empathy Associated With Differences in Pain and Functional Limitations After a Hand Surgeon Visit? Clin Orthop Relat Res 2018; 476:801-807. [PMID: 29481341 PMCID: PMC6260057 DOI: 10.1007/s11999.0000000000000077] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND In prior work we demonstrated that patient-rated physician empathy was the strongest driver of patient satisfaction after a visit to an orthopaedic hand surgeon. Data from the primary care setting suggest a positive association between physician empathy and clinical outcomes, including symptoms of the common cold. It is possible that an empathic encounter could make immediate and measureable changes in a patient's mindset, symptoms, and functional limitations. QUESTIONS/PURPOSES (1) Comparing patients who rated their physicians as perfectly empathic with those who did not, is there a difference in pre- to postvisit change in Patient Reported Outcome Measurement Information System (PROMIS) Upper Extremity Function scores? (2) Do patients who gave their physicians perfectly empathic ratings have a greater decrease in pre- to postvisit change in Pain Intensity, PROMIS Pain Interference, and PROMIS Depression scores? METHODS Between September 2015 and February 2016, based on the clinic patient flow, 134 new patients were asked to participate in this study. Eight patients were in a rush to leave the surgeon's office, which left us with a final cohort of 126 patients. Directly before and directly after the appointment with their physician, patients were asked to complete three PROMIS Computerized Adaptive Tests (CAT; Upper Extremity Function, Pain Interference, and Depression) as well as an ordinal rating of pain intensity. After the visit, participants were asked to rate their physician using the Consultation And Relational Empathy (CARE) measure. Based on prior experience, we dichotomized the CARE score anticipating a substantial skew: 54 patients (43%) rated their physician perfectly empathic. RESULTS Between patients who rated physicians as perfectly empathic and those who did not, there was no difference in the pre- to postvisit change in PROMIS Upper Extremity Function CAT score (perfect empathy: 0.84 ± 2.94; less than perfect empathy: -0.23 ± 3.12; mean difference: 0.23; 95% confidence interval [CI], -0.31 to 0.77; p = 0.054). There was a small decrease in Pain Intensity (perfect empathy: -0.96 ± 2.08; less than perfect empathy: -0.33 ± 1.03; mean difference: -0.60; 95% CI, -0.88 to -0.32; p = 0.028). There were no differences in PROMIS Pain Interference score (perfect empathy: -1.33 ± 2.85; less than perfect empathy: -1.37 ± 3.12; mean difference: -1.35; 95% CI, -1.88 to -0.83; p = 0.959) or PROMIS Depression scores (perfect empathy: -1.51 ± 4.02; less than perfect empathy : -1.21 ± 3.83; mean difference: -1.34; 95% CI, -2.03 to -0.65; p = 0.663). CONCLUSIONS A single visit with a surgeon rated perfectly empathic is not associated with change in upper extremity-specific limitations or coping mechanisms or a noticeable change in pain scores during the visit, as these differences were below the minimum clinically important difference. Future research should address the influence of empathy on patient-reported outcomes and physician empathy over time in contrast to a single office visit. LEVEL OF EVIDENCE Level II, prognostic study.
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Bikker AP, Fitzpatrick B, Murphy D, Forster L, Mercer SW. Assessing the Consultation and Relational Empathy (CARE) Measure in sexual health nurses' consultations. BMC Nurs 2017; 16:71. [PMID: 29204104 PMCID: PMC5702142 DOI: 10.1186/s12912-017-0265-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 11/13/2017] [Indexed: 12/30/2022] Open
Abstract
Background Increasingly healthcare policies emphasise the importance of person-centred, empathic care. Consequently, healthcare professionals are expected to demonstrate the ‘human’ aspects of care in training and in practice. The Consultation and Relational Empathy (CARE) Measure is a patient-rated measure of the interpersonal skills of healthcare practitioners. It has been widely validated for use by healthcare professionals in both primary and secondary care. This paper reports on the validity and reliability of the CARE Measure with sexual health nurses. Methods Patient questionnaires were collected for 943 consultations with 20 sexual health nurses. Participating patients self-completed the questionnaire immediately after the encounter with the nurse. The questionnaire included the ten item CARE Measure, the Patient Enablement Index, and overall satisfaction instruments. Construct validity was assessed through Spearman’s correlation and principal component analysis. Internal consistence was assessed through Cronbach’s alpha and the inter-rater reliability through Generalisability Theory. Data were collected in 2013 in Scotland. Results Female patients completed 68% of the questionnaires. The mean patient age was 28.8 years (standard deviation 9.8 years). Two of the 20 participating nurses withdrew from the study. Most patients (71.7%) regarded the CARE Measure items as very important to their consultation and the number of ‘not applicable’ and missing responses’ were low (2.6% and 0.1% respectively). The participating nurses had high CARE Measure scores; out of a maximum possible score of 50, the overall mean CARE measure score was 47.8 (standard deviation 4.4). The scores were moderately correlated with patient enablement (rho = 0.232, p = 0.001) and overall satisfaction (rho = 0.377, p = 0.001. Cronbach’s alpha showed the measure’s high internal consistency (Cronbach’s alpha coefficient = 0.95), but the inter-rater reliability could not be calculated due to the high achieved CARE Measure scores that varied little between nurses. Conclusions Within this clinical context the CARE Measure has high perceived relevance and face validity. The findings support construct validity and some evidence of reliability. The high CARE Measure scores may have been due to sample bias. A future study which ensures a representative sample of patients on a larger group of nurses is required to determine whether the measure can discriminate between nurses.
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Affiliation(s)
- Annemieke P Bikker
- Usher Institute for Population Sciences and Informatics, The University of Edinburgh, 9 BioQuarter, Little France Road, Edinburgh, EH16 4UX UK
| | - Bridie Fitzpatrick
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, 1 Horselethill Road, Glasgow, G12 9LX UK
| | - Douglas Murphy
- School of Medicine, University of Dundee, Mackenzie Building, Kirsty Semple Way, Dundee, DD2 4BF UK
| | - Lorraine Forster
- Sandyford Sexual Health Services, 2-6 Sandyford Place, Glasgow, G3 7NB UK
| | - Stewart W Mercer
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, 1 Horselethill Road, Glasgow, G12 9LX UK
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Viksveen P, Relton C. Depressed patients’ experiences with and perspectives on treatment provided by homeopaths. A qualitative interview study embedded in a trial. Eur J Integr Med 2017. [DOI: 10.1016/j.eujim.2017.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Foley H, Steel A. Patient perceptions of patient-centred care, empathy and empowerment in complementary medicine clinical practice: A cross-sectional study. ADVANCES IN INTEGRATIVE MEDICINE 2017. [DOI: 10.1016/j.aimed.2017.02.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Foley H, Steel A. Patient perceptions of clinical care in complementary medicine: A systematic review of the consultation experience. PATIENT EDUCATION AND COUNSELING 2017; 100:212-223. [PMID: 27693375 DOI: 10.1016/j.pec.2016.09.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 09/20/2016] [Accepted: 09/21/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE This review aims to describe the prevalence of empathy, empowerment and patient-centred clinical care experienced by patients in complementary medicine (CM) consultations. METHODS A systematic review was undertaken of original research exploring patient perceptions of CM clinical care. Ten databases were searched: Alt HealthWatch, AMED, CINAHL Plus, MEDLINE Complete, Cochrane Library, PubMed, Proquest Medical Collection, PsycInfo, Social Sciences Citation Index and Psychology Collection. Studies were included which reported patient perceptions of consultation with CM practitioners and were excluded where experimental methods controlled the nature of consultation processes. RESULTS Findings of included studies (n=34) were categorised under the a priori themes of empathy, empowerment and patient-centred care. This produced a substantial pool of qualitative data detailing patient-reported experiences which consistently confirmed occurrence of these themes in CM consultation. Quantitative data was correlative, yet was insufficient to definitively describe prevalence of such experiences. CONCLUSION While it is evident that CM consultations provide a patient experience of empathy, empowerment and patient-centredness, further research is warranted to quantify this experience before it can be defined as characteristic of CM clinical care. PRACTICE IMPLICATIONS This review draws attention to the potential role of CM as a resource for patients' psychosocial health needs.
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Affiliation(s)
- Hope Foley
- Endeavour College of Natural Health, 2/269 Wickham St., Fortitude Valley, QLD, 4006, Australia.
| | - Amie Steel
- Endeavour College of Natural Health, 2/269 Wickham St., Fortitude Valley, QLD, 4006, Australia; Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia
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Desborough J, Banfield M, Phillips C, Mills J. The process of patient enablement in general practice nurse consultations: a grounded theory study. J Adv Nurs 2016; 73:1085-1096. [DOI: 10.1111/jan.13199] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Jane Desborough
- Department of Health Services Research and Policy; Research School of Population Health; Australian National University; Canberra Australia
| | - Michelle Banfield
- National Institute for Mental Health Research; Australian National University; Canberra Australia
| | - Christine Phillips
- Social Foundations of Medicine; Australian National University Medical School; Australian National University; Canberra Australia
| | - Jane Mills
- School of Health & Biomedical Sciences; RMIT University; Melbourne Victoria Australia
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Satisfaction With the Outcome of Physical Therapist-Prescribed Exercise in Chronic Whiplash-Associated Disorders: Secondary Analysis of a Randomized Clinical Trial. J Orthop Sports Phys Ther 2016; 46:640-9. [PMID: 27374016 DOI: 10.2519/jospt.2016.6136] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Secondary analysis of a randomized clinical trial. Background Patient perception of the benefits gained from treatment is important, yet satisfaction with the outcome of treatment for chronic whiplash-associated disorders (WADs) has not been investigated. Objectives To investigate whether satisfaction with the outcome of treatment for chronic WAD changed over time, and whether there were group differences. Methods Two hundred sixteen people with chronic WAD (66% women; mean age, 40.4 years) participated in a 3-month program of physical therapist-led neck-specific exercises with or without a behavioral approach, or received a prescription of general physical activity. The main outcome was satisfaction with the outcome of treatment, assessed at baseline and 3, 6, and 12 months later. Additional outcomes were enablement and expectation fulfillment. Results Satisfaction improved over time in the 3 groups (odds ratio = 1.15; 95% confidence interval: 1.10, 1.20; P<.001). There was a significant group-by-time interaction (P<.001), with increased odds of being satisfied in the groups receiving neck-specific exercises compared to general physical activity. Enablement increased after completion of the intervention in all groups (P<.001). People who received neck-specific exercises reported greater enablement and expectation fulfillment than people prescribed general physical activity (P<.01). Conclusion Exercise interventions for chronic WAD led to increased satisfaction for 12 months following treatment that was unrelated to the type of exercise intervention received. Level of Evidence Therapy, level 1b. Registered January 22, 2012 at www.ClinicalTrials.gov (NCT01528579). J Orthop Sports Phys Ther 2016;46(8):640-649. Epub 3 Jul 2016. doi:10.2519/jospt.2016.6136.
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Davidson J, Jonas W. Individualized Homeopathy: A Consideration of Its Relationship to Psychotherapy. J Altern Complement Med 2016; 22:594-8. [PMID: 27285053 DOI: 10.1089/acm.2015.0365] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The benefit and potential mechanisms of action of homeopathy have long been debated. Almost entirely neglected has been the study of individualized homeopathy (IH) as a form of psychotherapy, which incorporates factors that are common to most therapies while using processes that are specific to IH. METHODS Recent research into the therapeutic components of IH is reviewed; similarities and differences between IH and other forms of psychotherapy are also described. RESULTS IH includes elements found in humanistic therapy and narrative medicine and additionally incorporates idiographic material in treatment selection. It is structured in a manner that takes maximum advantage of the components of the placebo effect, which could further expand its effectiveness beyond those conditions thought usually amenable to psychotherapy. CONCLUSIONS It is possible that IH entails specific psychotherapeutic processes in addition to possible therapeutic action of the homeopathic remedy, but the relative contributions of each remain to be determined. Suggestions are given for future research.
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Affiliation(s)
- Jonathan Davidson
- 1 Department of Psychiatry and Behavioral Sciences, Duke University Medical Center , Durham, NC
| | - Wayne Jonas
- 2 Samueli Institute, Georgetown School of Medicine and Uniformed Services University , Alexandria, VA
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Ferrante JM, Seaman K, Bator A, Ohman-Strickland P, Gundersen D, Clemow L, Puhl R. Impact of Perceived Weight Stigma among Underserved Women on Doctor-Patient Relationships. Obes Sci Pract 2016; 2:128-135. [PMID: 27293804 PMCID: PMC4902272 DOI: 10.1002/osp4.40] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objective The aim of this study was to evaluate how perception of weight stigma among underserved women with obesity impacts doctor–patient relationships. Methods This study consisted of an interviewer‐administered survey of 149 women with obesity (body mass index (BMI) > 30 kg m−2) immediately after their physician visit at four Federally Qualified Health Centers. Perceptions of weight stigma and physician empathy were measured using the Stigma Situations in Health Care instrument and Consultation and Relational Empathy (CARE) measure, respectively. Associations of CARE and Stigma scores with BMI and patient characteristics were analysed using Mantel–Haenszel chi‐squared test and ordinal logistic regression. Results The mean CARE score was 42.1 (standard deviation 8.4; range 11.0–50.0), and mean stigma score was 4.6 (standard deviation 7.6; range 0–43.0). Each increase in BMI category was associated with almost twofold increased odds of higher perception of stigma (odds ratio, 1.90, 95% confidence interval 1.30–2.78, P = 0.001). BMI was not associated with CARE. However, for each increase in stigma category, the odds of lower CARE score doubled (odds ratio, 0.52, 95% confidence interval 0.36–0.75, P = 0.0005). Conclusions While BMI was not associated with perception of physician empathy, higher frequency of weight stigmatizing situations was negatively associated with perception of physician empathy. Reducing weight stigma in primary care could improve doctor–patient relationships and quality of care in patients with obesity.
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Affiliation(s)
- Jeanne M Ferrante
- Department of Family Medicine and Community Health, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA; Rutgers-Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - KelliAnn Seaman
- Preliminary Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Alicja Bator
- Department of Family Medicine and Community Health, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Pamela Ohman-Strickland
- Department of Family Medicine and Community Health, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA; Rutgers-Cancer Institute of New Jersey, New Brunswick, New Jersey, USA; Department of Biostatistics, Rutgers-School of Public Health, Piscataway, New Jersey, USA
| | - Daniel Gundersen
- Department of Family Medicine and Community Health, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA; Rutgers-Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Lynn Clemow
- Department of Family Medicine and Community Health, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Rebecca Puhl
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, Connecticut, USA
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Chung VCH, Yip BHK, Yu ELM, Liu S, Ho RST, Sit RWS, Leung AWN, Wu JCY, Wong SYS. Patient Perceptions of Expression of Empathy From Chinese Medicine Clinicians in a Chinese Population: A Cross-Sectional Study. Medicine (Baltimore) 2016; 95:e3316. [PMID: 27124021 PMCID: PMC4998684 DOI: 10.1097/md.0000000000003316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
This study aims to examine the level of empathy perceived by patients receiving care from herbalists, acupuncturists and massage therapists and to investigate the factors that influence levels of perceived empathy.Participants who were 18 years or above; able to provide written informed consent; and able to read and write in Chinese without assistance were included. A total of 514 participants sampled from charity and semipublic Chinese medicine (CM) clinics in Hong Kong were recruited to assess levels of empathy perceived during various length of consultations (1-20 minutes) by the Chinese Consultation and Relational Empathy Measure (Chinese CARE). Multiple linear regressions were conducted to evaluate the associations between perceived levels of empathy and the type of CM practitioner consulted and participants' demographic and health characteristics.The average Chinese CARE total score for participants consulting CM practitioners was 34.3 of a maximum of 50. After adjusting for participants' health and demographic characteristics, acupuncturists received the highest ratings (P < 0.001), whereas massage therapists (P < 0.001) scored the lowest of the 3 modalities. Participants receiving social benefits (P = 0.013), those with longer waiting times (P = 0.002), and those with shorter consultation durations (P = 0.020) scored significantly lower on the Chinese CARE.The level of empathy perceived by participants using CM was similar to results found for those in conventional care, in contrast to findings in other geographical settings, where a high level of perceived empathy was a major motivator for participants to choose complementary medicine.
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Affiliation(s)
- Vincent C H Chung
- From the Jockey Club School of Public Health and Primary Care (VCHC, BHKY, ELMY, SL, RSTH, RWSS, SYSW), Hong Kong Institute of Integrative Medicine (VCHC, RWSS, JCYW, SYSW), and School of Chinese Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China (AWNL)
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Lafreniere JP, Rios R, Packer H, Ghazarian S, Wright SM, Levine RB. Burned Out at the Bedside: Patient Perceptions of Physician Burnout in an Internal Medicine Resident Continuity Clinic. J Gen Intern Med 2016; 31:203-208. [PMID: 26340808 PMCID: PMC4720641 DOI: 10.1007/s11606-015-3503-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 07/14/2014] [Accepted: 07/21/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Burnout is high among resident physicians and may be associated with suboptimal patient care and reduced empathy. OBJECTIVE To investigate the relationship between patient perceptions of empathy and enablement and physician burnout in internal medicine residents. DESIGN Cross-sectional, survey-based observational study between December 2012 and March 2013 in a resident continuity clinic located within a large urban academic primary care practice in Baltimore, Maryland. PARTICIPANTS Study participants were 44 PGY1-3 residents and a convenience sample of their English-speaking adult primary care patients (N = 244). MAIN MEASURES Patients rated their resident physicians using the Consultation and Relational Empathy Measure (CARE) and the Patient Enablement Instrument (PEI). Residents completed the Maslach Burnout Inventory (MBI). We tested for associations between resident burnout and patients' perceptions of resident empathy (CARE) and enablement (PEI) using multilevel regression analysis. KEY RESULTS Multilevel regression analyses indicated significant positive associations between physician depersonalization scores on the MBI and patient ratings of empathy (B = 0.28, SE = 0.17, p < 0.001) and enablement (B = 0.11, SE = 0.11, p = 0.02). Emotional exhaustion scores on the MBI were not significantly related to either patient outcome. CONCLUSIONS Patients perceived residents who reported higher levels of depersonalization as more empathic and enabling during their patient care encounters. The relationship between physician distress and patient perceptions of care has important implications for medical education and requires further study.
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Affiliation(s)
- Justin P Lafreniere
- Division of General Internal Medicine, Department of Medicine, Naval Medical Center Portsmouth, Portsmouth, VA, USA
- Department of Medicine, Uniformed Services University of the Health Sciences, F. Edward Hebert School of Medicine, Bethesda, MD, USA
| | - Rebeca Rios
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Hillary Packer
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Sharon Ghazarian
- Department of Pediatrics, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Scott M Wright
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Rachel B Levine
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.
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Bikker AP, Fitzpatrick B, Murphy D, Mercer SW. Measuring empathic, person-centred communication in primary care nurses: validity and reliability of the Consultation and Relational Empathy (CARE) Measure. BMC FAMILY PRACTICE 2015; 16:149. [PMID: 26493072 PMCID: PMC4619021 DOI: 10.1186/s12875-015-0374-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 10/16/2015] [Indexed: 12/30/2022]
Abstract
Background Empathic patient-centred care is central to high quality health encounters. The Consultation and Relational Empathy (CARE) Measure is a patient-rated experience measure of the interpersonal quality of healthcare encounters. The measure has been extensively validated and is widely used by doctors in primary care but has not been validated in nursing. This study assessed the validity and reliability of the CARE Measure in routine nurse consultations in primary care. Methods Seventeen nurses from nine general medical practices located in three Scottish Health Boards participated in the study. Consecutive patients (aged 16 years or older) were asked to self-complete a questionnaire containing the CARE Measure immediately after their clinical encounter with the nurse. Statistical analysis included Spearman’s correlation and principal component analysis (construct validity), Cronbach’s alpha (internal consistency), and Generalisability theory (inter-rater reliability). Results A total of 774 patients (327 male and 447 female) completed the questionnaire. Almost three out of four patients (73 %) felt that the CARE Measure items were very important to their current consultation. The number of ‘not applicable’ responses and missing values were low overall (5.7 and 1.6 % respectively). The mean CARE Measure score in the consultations was 45.9 and 48 % achieved the maximum possible score of 50. CARE Measure scores correlated in predicted ways with overall satisfaction and patient enablement in support of convergent and divergent validity. Factor analysis found that the CARE Measure items loaded highly onto a single factor. The measure showed high internal consistency (Cronbach’s alpha coefficient = 0.97) and acceptable inter-rater reliability (G = 0.6 with 60 patients ratings per nurse). The scores were not affected by patients’ age, gender, self-perceived overall health, living arrangements, employment status or language spoken at home. Conclusions The CARE Measure has high face and construct validity, and internal reliability in nurse consultations in primary care. Its ability to discriminate between nurses is sufficient for educational and quality improvement purposes.
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Affiliation(s)
- Annemieke P Bikker
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, 1 Horselethill Road, Glasgow, G12 9LX, UK.
| | - Bridie Fitzpatrick
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, 1 Horselethill Road, Glasgow, G12 9LX, UK.
| | - Douglas Murphy
- School of Medicine, University of Dundee, Mackenzie Building, Kirsty Semple Way, Dundee, DD2 4BF, UK.
| | - Stewart W Mercer
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, 1 Horselethill Road, Glasgow, G12 9LX, UK.
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Brugel S, Postma-Nilsenová M, Tates K. The link between perception of clinical empathy and nonverbal behavior: The effect of a doctor's gaze and body orientation. PATIENT EDUCATION AND COUNSELING 2015; 98:1260-5. [PMID: 26320820 DOI: 10.1016/j.pec.2015.08.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 08/04/2015] [Accepted: 08/04/2015] [Indexed: 05/28/2023]
Abstract
OBJECTIVES Clinical empathy is considered to be one of the most important skills for medical professionals. It is primarily conveyed by nonverbal behavior; however, little is known about the importance of different types of cues and their relation to engagement and sincerity as possible correlates of perceived clinical empathy (PCE). In this study, we explored the effect of doctor's gaze and body orientation on PCE with the help of 32 video vignettes. METHODS Actors impersonating medical interns displayed different combinations of gaze and body orientation while uttering an empathetic verbal statement. The video vignettes were evaluated in terms of the perceived clinical and general empathy, engagement and sincerity. RESULTS A principal component analysis revealed a possible single-factor solution for the scales measuring the two types of empathy, engagement and sincerity; therefore, they were subsumed under general perceived empathy (GPE). An analysis of variance showed a main effect of gaze and body orientation, with a stronger effect of gaze, on GPE. We subsequently performed a linear random effects analysis, which indicated possible gender-related differences in the perception of gaze. CONCLUSIONS The outcomes of our experiment confirm that both gaze and body orientation have an influence on the GPE. The effect of gaze, however, appears to be gender-dependent: in the experiment, males were perceived as slightly more empathetic with patient-centered gaze, while for females averted gaze resulted in higher GPE scores. PRACTICE IMPLICATIONS The findings are directly relevant in the context of medical communication training. Perception of clinical empathy supports medical information transfer, diagnosis quality and other patient outcomes.
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Affiliation(s)
- Sabrina Brugel
- Department of Communication and Information Sciences, Tilburg University, the Netherlands; Department of Medical Psychology, Academic Medical Center Amsterdam, the Netherlands.
| | - Marie Postma-Nilsenová
- Department of Communication and Information Sciences, Tilburg University, the Netherlands
| | - Kiek Tates
- Department of Communication and Information Sciences, Tilburg University, the Netherlands
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Patient-Provider Interactions Affect Symptoms in Gastroesophageal Reflux Disease: A Pilot Randomized, Double-Blind, Placebo-Controlled Trial. PLoS One 2015; 10:e0136855. [PMID: 26422466 PMCID: PMC4589338 DOI: 10.1371/journal.pone.0136855] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 08/08/2015] [Indexed: 01/03/2023] Open
Abstract
Background It is unclear whether the benefits that some patients derive from complementary and integrative medicine (CIM) are related to the therapies recommended or to the consultation process as some CIM provider visits are more involved than conventional medical visits. Many patients with gastrointestinal conditions seek out CIM therapies, and prior work has demonstrated that the quality of the patient-provider interaction can improve health outcomes in irritable bowel syndrome, however, the impact of this interaction on gastroesophageal reflux disease (GERD) is unknown. We aimed to assess the safety and feasibility of conducting a 2x2 factorial design study preliminarily exploring the impact of the patient-provider interaction, and the effect of an over-the-counter homeopathic product, Acidil, on symptoms and health-related quality of life in subjects with GERD. Methods 24 subjects with GERD-related symptoms were randomized in a 2x2 factorial design to receive 1) either a standard visit based on an empathic conventional primary care evaluation or an expanded visit with questions modeled after a CIM consultation and 2) either Acidil or placebo for two weeks. Subjects completed a daily GERD symptom diary and additional measures of symptom severity and health-related quality of life. Results There was no significant difference in GERD symptom severity between the Acidil and placebo groups from baseline to follow-up (p = 0.41), however, subjects who received the expanded visit were significantly more likely to report a 50% or greater improvement in symptom severity compared to subjects who received the standard visit (p = 0.01). Total consultation length, perceived empathy, and baseline beliefs in CIM were not associated with treatment outcomes. Conclusion An expanded patient-provider visit resulted in greater GERD symptom improvement than a standard empathic medical visit. CIM consultations may have enhanced placebo effects, and further studies to assess the active components of this visit-based intervention are warranted. Trial Registration ClinicalTrials.gov NCT01915173
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Lelorain S, Brédart A, Dolbeault S, Cano A, Bonnaud-Antignac A, Cousson-Gélie F, Sultan S. How does a physician's accurate understanding of a cancer patient's unmet needs contribute to patient perception of physician empathy? PATIENT EDUCATION AND COUNSELING 2015; 98:734-741. [PMID: 25817423 DOI: 10.1016/j.pec.2015.03.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 02/19/2015] [Accepted: 03/07/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Unmet supportive care needs of patients decrease patient perception of physician empathy (PE). We explored whether the accurate physician understanding of a given patient's unmet needs (AU), could buffer the adverse effect of these unmet needs on PE. METHODS In a cross-sectional design, 28 physicians and 201 metastatic cancer patients independently assessed the unmet supportive care needs of patients. AU was calculated as the sum of items for which physicians correctly rated the level of patient needs. PE and covariates were assessed using self-reported questionnaires. Multilevel analyses were carried out. RESULTS AU did not directly affect PE but acted as a moderator. When patients were highly expressive and when physicians perceived poor rapport with the patient, a high AU moderated the adverse effect of patient unmet needs on PE. CONCLUSION Physician AU has the power to protect the doctor-patient relationship in spite of high patient unmet needs, but only in certain conditions. PRACTICE IMPLICATIONS Physicians should be encouraged toward AU but warned that high rapport and patient low emotional expression may impede an accurate reading of patients. In this latter case, they should request a formal assessment of their patients' needs.
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Affiliation(s)
- Sophie Lelorain
- Univ Lille Nord de France, Department of Psychology, Lille, France; UDL3, SCALab UMR CNRS 9193, Villeneuve d'Ascq, France.
| | - Anne Brédart
- Institut Curie, Psycho-oncology Unit, Paris, France; Paris Descartes University, LPPS EA 4057-IUPDP, Boulogne-Billancourt, France
| | - Sylvie Dolbeault
- Institut Curie, Psycho-oncology Unit, Paris, France; Inserm, U 669, Paris, France; Univ Paris-Sud and Univ Paris Descartes, UMR-S0669, Paris, France
| | | | - Angélique Bonnaud-Antignac
- University of Nantes, EA4275 SPHERE 'bioStatistics, Pharmacoepidemiology and Human sciEnces Research', Nantes, France
| | - Florence Cousson-Gélie
- University of Montpellier 3, Laboratory Epsylon 'Dynamics of Human Abilities & Health Behaviors', Montpellier, France; ICM, Institut Régional du Cancer de Montpellier, Epidaure Prevention and Education Cancer Center, Montpellier, France
| | - Serge Sultan
- University of Montreal, Sainte Justine University Hospital Research Center, Montreal, Canada
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Poddubnaya T. Empathy problematic in psychological aspects of professional medical care (review). КОНСУЛЬТАТИВНАЯ ПСИХОЛОГИЯ И ПСИХОТЕРАПИЯ 2015. [DOI: 10.17759/cpp.2015230202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The article covers summary report of the main aspects of empathy research in medical care. Data of an empathy level diagnostics depending on social aspects is pre¬sented, as well as an issue of empathy consideration as a stable personal characteristic, its dependency on experience and doctor's specialization, context of medical activity (necessary pain infliction, emergency aid assistance) is discussed. Aspects of empathic communication for medical workers of various specialties, inter alia psychiatrists and oncologists, as well as communication strategies, developed for coping with cocurrent negative emotions are analyzed. An example of a medical interview facilitating the quality of interpersonal relationship in the pair patient-doctor alliance" is given. In conclusion there are presented actual scientific contra¬dictions and set the possible main lines of future researches.
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Understanding the barriers to physician error reporting and disclosure: a systemic approach to a systemic problem. J Patient Saf 2014; 10:45-51. [PMID: 24553443 DOI: 10.1097/pts.0b013e31829e4b68] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The issues of medical errors and medical malpractice have stimulated significant interest in establishing transparency in health care, in other words, ensuring that medical professionals formally report medical errors and disclose related outcomes to patients and families. However, research has amply shown that transparency is not a universal practice among physicians. METHODS A review of the literature was carried out using the search terms "transparency," "patient safety," "disclosure," "medical error," "error reporting," "medical malpractice," "doctor-patient relationship," and "physician" to find articles describing physician barriers to transparency. RESULTS The current literature underscores that a complex Web of factors influence physician reluctance to engage in transparency. Specifically, 4 domains of barriers emerged from this analysis: intrapersonal, interpersonal, institutional, and societal. CONCLUSION Transparency initiatives will require vigorous, interdisciplinary efforts to address the systemic and pervasive nature of the problem. Several ethical and social-psychological barriers suggest that medical schools and hospitals should collaborate to establish continuity in education and ensure that knowledge acquired in early education is transferred into long-term learning. At the institutional level, practical and cultural barriers suggest the creation of supportive learning environments and private discussion forums where physicians can seek moral support in the aftermath of an error. To overcome resistance to culture transformation, incremental change should be considered, for example, replacing arcane transparency policies and complex reporting mechanisms with clear, user-friendly guidelines.
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Lam CLK, Yu EYT, Lo YYC, Wong CKH, Mercer SM, Fong DYT, Lee A, Lam TP, Leung GM. Having a Family Doctor is Associated with Some Better Patient-Reported Outcomes of Primary Care Consultations. Front Med (Lausanne) 2014; 1:29. [PMID: 25593904 PMCID: PMC4292188 DOI: 10.3389/fmed.2014.00029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 08/25/2014] [Indexed: 01/14/2023] Open
Abstract
Background: Hong Kong (HK) has pluralistic primary care that is provided by a variety of doctors. The aim of our study was to assess patient-reported outcomes of primary care consultations in HK and whether having a family doctor (FD) made any difference. Methods: We interviewed by telephone 3148 subjects from 5174 contacted households (response rate 60.8%) randomly selected from the general population of HK about the experience of their last primary care consultations in September 2007 and April 2008. We compared the patient-reported outcomes (PRO) and patient-centered process of care in those with a FD, those with other types of regular primary care doctors (ORD) and those without any regular primary care doctor (NRD). PRO included patient enablement, global improvement in health, overall satisfaction, and likelihood of recommending their doctors to family and friends. Patient-centered process of care indicators was explanations about the illness, and address of patient’s concerns. Results: One thousand one hundred fifty, 746, and 1157 reported to have FD, ORD, and NRD, respectively. Over 80% of those with FD consulted their usual primary care doctors in the last consultation compared with 27% of those with NRD. Compared with subjects having ORD or NRD, subjects with FD reported being more enabled after the consultation and were more likely to recommend their doctors to family and friends. Subjects with FD and ORD were more likely than those having NRD to report a global improvement in health and satisfaction. FD group was more likely than the other two groups to report receiving an explanation on the diagnosis, nature, and expected course of the illness, and having their concerns addressed. Patient enablement was associated with explanation of diagnosis, nature, and expected course of illness, and address of patient’s concerns. Conclusion: People with a regular FD were more likely to feel being enabled and to experience patient-centered care in consultations.
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Affiliation(s)
- Cindy L K Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong , Hong Kong , China
| | - Esther Y T Yu
- Department of Family Medicine and Primary Care, The University of Hong Kong , Hong Kong , China
| | - Yvonne Y C Lo
- Department of Family Medicine and Primary Care, The University of Hong Kong , Hong Kong , China
| | - Carlos K H Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong , Hong Kong , China
| | - Stewart M Mercer
- Section of General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow , Glasgow , UK
| | - Daniel Y T Fong
- School of Nursing, The University of Hong Kong , Hong Kong , China
| | - Albert Lee
- Centre for Health Education and Health Promotion, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong , Hong Kong , China
| | - Tai Pong Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong , Hong Kong , China
| | - Gabriel M Leung
- School of Public Health, The University of Hong Kong , Hong Kong , China
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Ahrweiler F, Neumann M, Goldblatt H, Hahn EG, Scheffer C. Determinants of physician empathy during medical education: hypothetical conclusions from an exploratory qualitative survey of practicing physicians. BMC MEDICAL EDUCATION 2014; 14:122. [PMID: 24952736 PMCID: PMC4080581 DOI: 10.1186/1472-6920-14-122] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 06/10/2014] [Indexed: 05/09/2023]
Abstract
BACKGROUND Empathy is an outcome-relevant physician characteristic and thus a crucial component of high-quality communication in health care. However, the factors that promote and inhibit the development of empathy during medical education have not been extensively researched. Also, currently there is no explicit research on the perspective of practicing physicians on the subject. Therefore the aim of our study was to explore physicians' views of the positive and negative influences on the development of empathy during their medical education, as well as in their everyday work as physicians. METHOD We administered a written Qualitative Short Survey to 63 physicians in seven specialties. They were able to respond anonymously. Our open-ended question was: "What educational content in the course of your studies and/or your specialist training had a positive or negative effect on your empathy?" We analyzed the data using thematic content analysis following Mayring's approach. RESULTS Forty-two physicians took part in our survey. All together, they mentioned 68 specific factors (37 positive, 29 negative, 2 neutral) from which six themes emerged: 1. In general, medical education does not promote the development of empathy. 2. Recognizing the psycho-social dimensions of care fosters empathy. 3. Interactions with patients in medical practice promote empathy. 4. Physicians' active self-development through reflective practice helps the development of empathy. 5. Interactions with colleagues can both promote and inhibit empathy through their role modeling of empathic and non-empathic behavior. 6. Stress, time pressure, and adverse working conditions are detrimental to empathy development. CONCLUSIONS Our results provide an overview of what might influence the development of clinical empathy, as well as hypothetical conclusions about how to promote it. Reflective practice seems to be lacking in current medical curricula and could be incorporated. Raising physicians' awareness of the psycho-social dimension of disease, and of the impact of peer influence and role modeling, seems promising in this regard, too. Stress and well-being seem to be closely related to physician empathy, and their modulation must take into account individual, social, and organizational factors. Further research should investigate whether or how these hypothetical conclusions can deepen our understanding of the determinants of physician empathy in order to help its promotion.
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Affiliation(s)
- Florian Ahrweiler
- Integrated Curriculum for Anthroposophic Medicine, Institute for Integrative Medicine, School of Medicine, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany
- Medizinische Klinik, Augusta-Kranken-Anstalt, Bergstraße 26, 44791 Bochum, Germany
| | - Melanie Neumann
- Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany
| | - Hadass Goldblatt
- Department of Nursing, Faculty of Social Welfare & Health Sciences, University of Haifa, Mount Carmel, 3498838 Haifa, Israel
| | - Eckhart G Hahn
- Gesellschaft für Berufliche Fortbildung, Forschung und Entwicklung an der Medizinischen Klinik 1, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany
| | - Christian Scheffer
- Integrated Curriculum for Anthroposophic Medicine, Institute for Integrative Medicine, School of Medicine, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany
- Center for Educational Research, School of Medicine, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany
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Steinhausen S, Ommen O, Thüm S, Lefering R, Koehler T, Neugebauer E, Pfaff H. Physician empathy and subjective evaluation of medical treatment outcome in trauma surgery patients. PATIENT EDUCATION AND COUNSELING 2014; 95:53-60. [PMID: 24411659 DOI: 10.1016/j.pec.2013.12.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Revised: 11/19/2013] [Accepted: 12/03/2013] [Indexed: 05/14/2023]
Abstract
OBJECTIVE To analyze whether patients' perception of their medical treatment outcome is higher among patients who experienced a higher empathy by trauma surgeons during their stay in hospital. METHODS 127 patients were surveyed six weeks after discharge from the trauma surgical general ward. Subjective evaluation of medical treatment outcome was measured with the corresponding scale from the Cologne Patient Questionnaire. Clinical empathy was assessed by using the CARE measure. The influence of physician empathy and control variables on a dichotomized index of subjective evaluation of medical treatment outcome was identified with a logistic regression. RESULTS 120 patients were included in the logistic regression analysis. Compared to patients with physician empathy ratings of less than 30 points, patients with ratings of 41 points or higher have a 20-fold higher probability to be in the group with a better medical treatment outcome on the CPQ-scale (α-level<.001, R(2) 46.9). CONCLUSION Findings emphasize the importance of a well-functioning relationship between physician and patient even in a surgical setting where the focus is mostly on the bare medical treatment. PRACTICE IMPLICATIONS Communication trainings i.e. in surgical education can be an effective way to improve the ability to show empathy with patients' concerns.
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Affiliation(s)
- Simone Steinhausen
- Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Campus Cologne-Merheim, Germany.
| | - Oliver Ommen
- Federal Center for Health Education (BZgA), Cologne, Germany
| | - Sonja Thüm
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), Faculty of Human Science and Faculty of Medicine, University of Cologne, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Campus Cologne-Merheim, Germany
| | | | - Edmund Neugebauer
- Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Campus Cologne-Merheim, Germany
| | - Holger Pfaff
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), Faculty of Human Science and Faculty of Medicine, University of Cologne, Germany
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Steel A, Adams J, Sibbritt D, Broom A, Gallois C, Frawley J. Determinants of Women Consulting with a Complementary and Alternative Medicine Practitioner for Pregnancy-Related Health Conditions. Women Health 2014; 54:127-44. [DOI: 10.1080/03630242.2013.876488] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Bell IR, Boyer NN. Homeopathic medications as clinical alternatives for symptomatic care of acute otitis media and upper respiratory infections in children. Glob Adv Health Med 2014; 2:32-43. [PMID: 24381823 PMCID: PMC3833578 DOI: 10.7453/gahmj.2013.2.1.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The public health and individual risks of inappropriate antibiotic prescribing and conventional over-the-counter symptomatic drugs in pediatric treatment of acute otitis media (AOM) and upper respiratory infections (URIs) are significant. Clinical research suggests that over-the-counter homeopathic medicines offer pragmatic treatment alternatives to conventional drugs for symptom relief in children with uncomplicated AOM or URIs. Homeopathy is a controversial but demonstrably safe and effective 200-year-old whole system of complementary and alternative medicine used worldwide. Numerous clinical studies demonstrate that homeopathy accelerates early symptom relief in acute illnesses at much lower risk than conventional drug approaches. Evidence-based advantages for homeopathy include lower antibiotic fill rates during watchful waiting in otitis media, fewer and less serious side effects, absence of drug-drug interactions, and reduced parental sick leave from work. Emerging evidence from basic and preclinical science research counter the skeptics' claims that homeopathic remedies are biologically inert placebos. Consumers already accept and use homeopathic medicines for self care, as evidenced by annual US consumer expenditures of $2.9 billion on homeopathic remedies. Homeopathy appears equivalent to and safer than conventional standard care in comparative effectiveness trials, but additional well-designed efficacy trials are indicated. Nonetheless, the existing research evidence on safety supports pragmatic use of homeopathy in order to “first do no harm” in the early symptom management of otherwise uncomplicated AOM and URIs in children.
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Affiliation(s)
- Iris R Bell
- Department of Family and Community Medicine, The University of Arizona College of Medicine and College of Nursing, The University of Arizona, Tucson, United States
| | - Nancy N Boyer
- Private Practice, Rochester, New York, United States
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Murphy J, Mercer SW, Duncan EAS. A pilot study to explore the feasibility, validity and reliability of a visual version of the CARE Measure. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2013. [DOI: 10.12968/ijtr.2013.20.9.460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Joan Murphy
- of Talking Mats, Stirling University Innovation Park, Stirling, Scotland, UK
| | - Stewart W Mercer
- at the Institute of Health and Wellbeing, University of Glasgow, Scotland, UK
| | - Edward AS Duncan
- Nursing Midwifery and Allied Health Professions Research Unit, University of Stirling, Scotland, UK
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Same difference? Complementary therapy consultations delivered in NHS and private settings—A qualitative study. Eur J Integr Med 2013. [DOI: 10.1016/j.eujim.2013.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Salles SAC, Ayres JRDCM. A consulta homeopática: examinando seu efeito em pacientes da atenção básica. ACTA ACUST UNITED AC 2013. [DOI: 10.1590/s1414-32832013005000010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
O artigo analisa resultados de pesquisa que investigou, sob o prisma da integralidade do cuidado, a contribuição da inserção experimental da atenção homeopática em centro de saúde-escola. São examinados os efeitos da consulta homeopática na perspectiva dos usuários, por meio de dados obtidos em grupo de pacientes acompanhados por um período médio de 12 meses. Tomam-se, para análise, as narrativas desses participantes em grupos focais e os resultados obtidos com a aplicação de questionário desenvolvido na Escócia para avaliar o efeito das consultas médicas na atenção primária. Os resultados sugerem que, enquanto tecnologia de cuidado, a abordagem homeopática utilizada neste estudo é favorecedora da integralidade e depositária de qualidades que merecem uma maior atenção e investigação mais ampla para que possa ser avaliada em seus diferentes modelos de inserção na saúde publica.
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Eyles C, Leydon GM, Brien SB. Forming connections in the homeopathic consultation. PATIENT EDUCATION AND COUNSELING 2012; 89:501-506. [PMID: 22370197 DOI: 10.1016/j.pec.2012.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Revised: 01/31/2012] [Accepted: 02/01/2012] [Indexed: 05/31/2023]
Abstract
OBJECTIVE A previous study which explored homeopathic practitioners' in depth understanding and experiences of homeopathic consultations identified "connecting" as a key component of the consultation. This paper reports on "connecting" and its role in the consultation. METHOD Using a qualitative grounded theory approach data was collected from homeopaths using in-depth interviews, observations of homeopathic consultations and solicited practitioner reflective diaries. Constant comparison assisted code, concept and category formation to form a model of the UK classical homeopathic consultation. RESULTS "Connecting", describes a complex notion of relationship in the homeopathic consultation consisting of four dimensions, and performs several roles within the consultation that enable practitioners to elicit symptoms, identify expectations, assist with prescribing, help patients engage with homeopathic principles and stimulate healing. CONCLUSION This study shows the homeopath as an important component of the therapeutic context forming complex relationships and using communication that is skills based and inductively shaped to interpret and respond to each individual patient and their narrative in the consultation. PRACTICE IMPLICATIONS This study could have implications for teachers, students and practitioners of homeopathy by influencing training needs, and could prove instructive for other clinicians as homeopaths' communication style could be used to augment other consultations.
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Affiliation(s)
- Caroline Eyles
- University of Southampton, Primary Care & Population Sciences, Aldermoor Health Centre, United Kingdom.
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Scheffer C, Tauschel D, Neumann M, Lutz G, Cysarz D, Heusser P, Edelhäuser F. Integrative medical education: educational strategies and preliminary evaluation of the Integrated Curriculum for Anthroposophic Medicine (ICURAM). PATIENT EDUCATION AND COUNSELING 2012; 89:447-454. [PMID: 22738823 DOI: 10.1016/j.pec.2012.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Revised: 03/20/2012] [Accepted: 04/15/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES the development and preliminary evaluation of a new medical program aimed at educating students in patient-centered integrative care and developing appropriate educational strategies. METHODS The Integrated Curriculum for Anthroposophic Medicine (ICURAM) was developed with modules on anthroposophic medicine integrated into the full 6 years of the regular medical curriculum. The educational strategy is the ESPRI(2)T approach, combining Exploratory learning, Supported participation, Patient-based learning, Reflective practice, Integrated learning, an Integrative approach and Team-based learning. The student participation, assessed based on the number of credit points earned per year (ctp/year) through the ICURAM (1 ctp=30 h workload), served as a preliminary indicator of student interest. RESULTS Of the 412 55%medical students participated in the program: 16% full participation (≥ 4 ctp/year), 18% partial participation (1-3.99 ctp/year) and 22% occasional participation (0.25-0.99 ctp/year). The amount of additional workload taken on by students was between 7.8h/year for occasional participants, 33 h/year for partial participants and 84 h/year for full participants. CONCLUSION More than half of medical students were willing to invest a significant amount of additional time in the optional program. PRACTICE IMPLICATIONS An integrative medical curriculum with a student-centered educational strategy seems to be of interest to most medical students.
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Affiliation(s)
- Christian Scheffer
- Integrated Curriculum for Anthroposophic Medicine, Theory of Medicine, Integrative and Anthroposophic Medicine, Faculty of Health, Witten/Herdecke University, Germany.
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Jani BD, Blane DN, Mercer SW. The role of empathy in therapy and the physician-patient relationship. ACTA ACUST UNITED AC 2012; 19:252-7. [PMID: 23128100 DOI: 10.1159/000342998] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This paper seeks to give an overview of the role of clinical empathy in therapy and in the physician-patient relationship. Researchers have offered definitions of empathy in the clinical context, and a number of validated measures exist. There is evidence from the health-related research literature to support the positive association of clinical empathy with improved therapeutic outcomes in a wide range of clinical settings. Clinical empathy is also understood to be a crucial component of the physician-patient therapeutic relationship. Barriers to the development and expression of empathy in the clinical context are explored, and ways of enhancing empathy discussed.
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Affiliation(s)
- Bhautesh Dinesh Jani
- General Practice and Primary Care, Institute of Health and Well Being, University of Glasgow, UK
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Neumann M, Scheffer C, Tauschel D, Lutz G, Wirtz M, Edelhäuser F. Physician empathy: definition, outcome-relevance and its measurement in patient care and medical education. GMS ZEITSCHRIFT FUR MEDIZINISCHE AUSBILDUNG 2012; 29:Doc11. [PMID: 22403596 PMCID: PMC3296095 DOI: 10.3205/zma000781] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Revised: 07/12/2011] [Accepted: 10/14/2011] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The present study gives a brief introduction into 1. the definition of physician empathy (PE) and 2. its influence on patients' health outcomes. Furthermore 3. we present assessment instruments to measure PE from the perspective of the patient and medical student. The latter topic will be explored in detail as we conducted a pilot study on the German versions of two self-assessment instruments of empathy, which are mostly used in medical education research, namely the "Jefferson Scale of Physician Empathy, Student Version" (JSPE-S) and the "Interpersonal Reactivity Index" (IRI). METHODS We first present an overview of the current empirical and theoretical literature on the definition and outcome-relevance of PE. Additionally, we conducted basic psychometric analyses of the German versions of the JSPE-S and the IRI. Data for this analyses is based on a cross-sectional pilot-survey in N=44 medical students and N=63 students of other disciplines from the University of Cologne. RESULTS PE includes the understanding of the patient as well as verbal and non-verbal communication, which should result in a helpful therapeutic action of the physician. Patients' health outcomes in different healthcare settings can be improved considerably from a high quality empathic encounter with their clinician. Basic psychometric results of the German JSPE-S and IRI measures show first promising results. CONCLUSION PE as an essential and outcome-relevant element in the patient-physician relationship requires more consideration in the education of medical students and, thus, in medical education research. The German versions of the JSPE-S and IRI measures seem to be promising means to evaluate these education aims and to conduct medical education research on empathy.
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Affiliation(s)
- Melanie Neumann
- Witten/Herdecke University, Faculty of Health, School of Medicine, Integrated Curriculum for Anthroposophic Medicine (ICURAM) at the Gerhard Kienle Chair for Medical Theory, Integrative and Anthroposophic Medicine, Witten, Germany.
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Mercer SW, Jani BD, Maxwell M, Wong SYS, Watt GCM. Patient enablement requires physician empathy: a cross-sectional study of general practice consultations in areas of high and low socioeconomic deprivation in Scotland. BMC FAMILY PRACTICE 2012; 13:6. [PMID: 22316293 PMCID: PMC3329411 DOI: 10.1186/1471-2296-13-6] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Accepted: 02/08/2012] [Indexed: 12/05/2022]
Abstract
Background Patient 'enablement' is a term closely aligned with 'empowerment' and its measurement in a general practice consultation has been operationalised in the widely used patient enablement instrument (PEI), a patient-rated measure of consultation outcome. However, there is limited knowledge regarding the factors that influence enablement, particularly the effect of socio-economic deprivation. The aim of the study is to assess the factors influencing patient enablement in GP consultations in areas of high and low deprivation. Methods A questionnaire study was carried out on 3,044 patients attending 26 GPs (16 in areas of high socio-economic deprivation and 10 in low deprivation areas, in the west of Scotland). Patient expectation (confidence that the doctor would be able to help) was recorded prior to the consultation. PEI, GP empathy (measured by the CARE Measure), and a range of other measures and variables were recorded after the consultation. Data analysis employed multi-level modelling and multivariate analyses with the PEI as the dependant variable. Results Although numerous variables showed a univariate association with patient enablement, only four factors were independently predictive after multilevel multivariate analysis; patients with multimorbidity of 3 or more long-term conditions (reflecting poor chronic general health), and those consulting about a long-standing problem had reduced enablement scores in both affluent and deprived areas. In deprived areas, emotional distress (GHQ-caseness) had an additional negative effect on enablement. Perceived GP empathy had a positive effect on enablement in both affluent and deprived areas. Maximal patient enablement was never found with low empathy. Conclusions Although other factors influence patient enablement, the patients' perceptions of the doctors' empathy is of key importance in patient enablement in general practice consultations in both high and low deprivation settings.
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Affiliation(s)
- Stewart W Mercer
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, 1 Horselethill Road, Glasgow, UK.
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Birhanu Z, Assefa T, Woldie M, Morankar S. Predictors of perceived empathy among patients visiting primary health-care centers in central Ethiopia. Int J Qual Health Care 2012; 24:161-8. [PMID: 22302068 DOI: 10.1093/intqhc/mzs001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Empathy is crucial to the achievement of patient centeredness consultations. However, it has not been frequently studied particularly in resource-limited settings. OBJECTIVE To identify predictors of patient reports indicating greater empathy among providers during patient visit to primary health-care facilities. PARTICIPANTS A cross-sectional study was conducted to assess the level of satisfaction among 768 out-patients, who consecutively visited six health centers in central Ethiopia. Patients were recruited from health centers under study based on proportional to size allocation. Multiple linear regression was used to assess the relationship between empathy scores and other patient factors. RESULTS The mean perceived empathy score was 31.34 ± 8.37 (range of possible values: 10-50). Patient-related factors that were negatively associated with perceived empathy were Tigre and Guraghe ethnicity [β = -4.45; 95% confidence interval (CI) = -6.86 to -2.03], Wakefena religion (β = -2.09; 95% CI = -3.82 to -0.35), lack of privacy during consultation (β = -1.62; 95% CI = -2.57 to -0.68), involvement of family in consultation (β = -1.45; 95% CI = -2.17 to -0.12) and not revealing one's own private issues (β = -1.25; 95% CI = -2.17 to -0.33). Positive associations with provider empathy scores were found for those who reported knowing their provider (β = 2.42; 95 CI = 1.70 to 4.13), non-verbal communication (β = 0.88; 95% CI = 0.80 to 0.96) and perceived technical competency (β = 0.12; 95% CI = 0.05 to 0.19). CONCLUSIONS Perceived empathy in this study was lower than the findings reported in earlier studies. Health-care providers committed to the delivery of patient-centered care should take note of the determinants of better empathy as perceived by their clients.
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Affiliation(s)
- Zewdie Birhanu
- Department of Health Education and Behavioral Sciences, College of Public Health and Medical Sciences, Jimma University, Ethiopia.
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Bell IR, Koithan M, Pincus D. Methodological implications of nonlinear dynamical systems models for whole systems of complementary and alternative medicine. ACTA ACUST UNITED AC 2012; 19 Suppl 1:15-21. [PMID: 22327547 DOI: 10.1159/000335183] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This paper focuses on the worldview hypotheses and research design approaches from nonlinear dynamical complex systems (NDS) science that can inform future studies of whole systems of complementary and alternative medicine (WS-CAM), e.g., Ayurveda, traditional Chinese medicine, and homeopathy. The worldview hypotheses that underlie NDS and WS-CAM (contextual, organismic, interactive-integrative - Pepper, 1942) overlap with each other, but differ fundamentally from those of biomedicine (formistic, mechanistic). Differing views on the nature of causality itself lead to different types of study designs. Biomedical efficacy studies assume a simple direct mechanistic cause-effect relationship between a specific intervention and a specific bodily outcome, an assumption less relevant to WS-CAM outcomes. WS-CAM practitioners do not necessarily treat a symptom directly. Rather, they intervene to modulate an intrinsic central imbalance of the person as a system and to create a more favorable environmental context for the emergence of health, e.g., with dietary changes compatible with the constitutional type. The rebalancing of the system thereby fosters the emergence of indirect, diffuse, complex effects throughout the person and the person's interactions with his/her environment. NDS theory-driven study designs thus have the potential for greater external and model validity than biomedically driven efficacy studies (e.g., clinical trials) for evaluating the indirect effects of WS-CAM practices. Potential applications of NDS analytic techniques to WS-CAM include characterizing different constitutional types and documenting the evolution and dynamics of whole-person healing and well-being over time. Furthermore, NDS provides models and methods for examining interactions across organizational scales, from genomic/proteomic/metabolomic networks to individuals and social groups.
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Affiliation(s)
- Iris R Bell
- Department of Family and Community Medicine, The University of Arizona, Tucson, AZ 85719-5052, USA.
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