Novel experiment illuminates importance of doctor-patient relationship

Published on January 29, 2013 at 5:09 AM · No Comments

In the second portion of the experiment,each physician was introduced to a patient and asked to perform a standardized clinical examination, which was conducted in a typical exam room for approximately 20 minutes. (The clinical exam was performed in order to establish a realistic rapport between the physician and patient before fMRI scanning took place, and was comparable to a standard U.S. doctor's appointment.) At this point the physician also answered a questionnaire, the Interpersonal Reactivity Index, used to measure the participant's self-reported perspective-taking skills.

During the third step, says Jensen, the physician and patient were led into the scanner room. "The physician went inside the scanner and was equipped with a remote control that could activate the 'analgesic device' when prompted," she explains. Mirrors inside the scanner enabled physicians to maintain eye contact with the patient, who was seated on a chair next to the scanner's bed and hooked up to both the thermal pain stimulator and the pain-relieving device.

Then, in a randomized order, physicians were instructed to either treat a patient's pain or to press a control button that provided no relief. When physicians were told not to activate pain relief, the "patient" exhibited a painful facial expression while the physicians watched. When the physicians were instructed to treat the patients' pain, they could see that the subjects' faces were neutral and relaxed, the result of pain relief. During these doctor-patient interactions, fMRI scans measured the doctors' brain activations.

Following the scanning session, the physicians were removed from the scanner and told exactly how the experiment had been performed, says Jensen. "If the physician did not agree with the deceptive component of the study, they were given the opportunity to withdraw their data. No one did this."

As predicted, the authors found that while treating patients, the physicians activated the right VLPFC region of the brain, a region previously implicated in the placebo response. Furthermore, Jensen adds, the physicians' ability to take the patients' viewpoints correlated to brain activations and subjective ratings; physicians who reported high perspective-taking skills were more likely to show activation in the rACC brain region, which is associated with reward.

"We already know that the physician-patient relationship provides solace and can even relieve many symptoms," adds Kaptchuk. "Now, for the first time, we've shown that caring for patients encompasses a unique neurobiology in physicians. Our ultimate goal is to transform the 'art of medicine' into the 'science of care,' and this research is an important first step in this process as we continue investigations to find out how patient-clinician interactions can lead to measurable clinical outcomes in patients."

Source: Beth Israel Deaconess Medical Center

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