Patients with ‘empathic’ GP at reduced risk of early death: Research

Evelyn Lewin

9/07/2019 3:14:17 PM

The researchers said the potential impact of empathy is ‘comparable to prescribing medicines’.

Dr Vicki Kotsirilos
Patients who have a good doctor–patient relationship have ‘greater satisfaction’ and improved health outcomes, says Dr Vicki Kotsirilos.

‘When we can demonstrate empathy, kindness and compassion towards our patients, they’re more likely to trust us and take on our advice for lifestyle and behavioural changes to manage their disease.’
That is Associate Professor Dr Vicki Kotsirilos, founding Chair of the RACGP Specific Interests Integrative Medicine Network.
Her comments come in response to a new study, published in the Annals of Family Medicine, which found that patients who rated their GPs as being more empathic had reduced risk of early mortality.
Those findings don’t surprise Dr Kotsirilos.
‘The doctor–patient relationship is crucial to developing the trust of the patient and helping empower our patients to take more control of their health,’ she told newsGP.
‘This ultimately is more likely to lead to positive health outcomes.’
This research was a population-based prospective cohort study of 49 general practices in the UK. It included 867 individuals with screen-detected type 2 diabetes who were followed up for an average of ten years.
Twelve months after diagnosis, patients assessed GP empathy and their experiences of diabetes care during the previous year, using the consultation and rational empathy (CARE) measure questionnaire.
The study found that, of the 628 participants with a completed CARE score, 120 (19%) experienced a cardiovascular disease (CVD) event, and 132 (21%) died during follow up.
Compared with the lowest end, higher empathy scores were associated with a lower risk of CVD events (although not statistically significant) and a lower risk of all-cause mortality.
The authors therefore found that positive patient experiences of practitioner empathy in the year after diagnosis of type 2 diabetes may be associated with beneficial long-term clinical outcomes.
‘In trying to manage the growing burden of chronic preventable disease, we’re increasingly moving towards precision healthcare, target-driven care and technology-based assessment, while at the same time focusing less on the human, interpersonal empathic aspects of care,’ said Dr Hajira Dambha-Miller, a GP and researcher at the Department of Public Health and Primary Care, University of Cambridge.
‘Our findings suggest that these more human elements of healthcare early in the course of diabetes, may be important in their long-term health outcomes.
‘The potential impact is considerable and comparable to prescribing medicines but without the associated problems of side effects or non-adherence,’ Dr Dambha-Miller said.
However, the authors say that further work is needed to understand which aspects of patient perceptions of empathy might influence health outcomes, and how to incorporate such findings when educating and training practitioners.
While this research paints a hopeful picture for patients of empathic GPs, the future might not be as bright for the doctors themselves.
In a story for The Conversation, Open University health lecturer Dr Rajvinder Samra said that female doctors show more empathy than their male counterparts.
While she says some people suggest that might make them ‘better doctors’, she said that it ‘may also take a terrible toll on their mental health’. 
And therein lies the rub.
Of course, it makes sense for doctors to be empathic towards their patients, and it’s heartening to see evidence pointing towards its benefits.
But for GPs whose plates are already overflowing, does it put extra pressure to keep ‘empathy’ top of mind throughout pressured consults when there are multiple issues to tackle?
Dr Kotsirilos doesn’t think so – as long as there is adequate time for consults.
To ensure that happens, she says it’s worth booking longer consultations so GPs have enough time to tackle both the issue at hand, and all the lifestyle advice recommended.
She also believes it’s key to book patients in for more regular monitoring.
To prevent feeling burnt out, she says it’s also ‘really important that we [as GPs] refresh ourselves in between patients’.
While Dr Kotsirilos says empathy can be innate, she says it can also be learned by role-modelling from more experienced doctors.
She says keeping consultations ‘patient-centred’ is a key way to practice this skill.
‘So when we’re sitting with our patients, it’s really important to be actively listening, connecting with them, and giving them a patient-centred consultation.
‘If we’re distracted by computers, by mobile phones ringing, disturbances from outside, that can create a disconnect.’
Dr Kotsirilos says the more empathy a GP shows during consults, the more likely a patient is to get ‘back on board’ if they deviate from optimal management of their health.
‘There are surveys that show patients who have developed a good doctor–patient relationship, where the doctor does spend more time with them and reinforces lifestyle advice, do show greater satisfaction and value their doctors who spend more time with them,’ Dr Kotsirilos said.
‘Ultimately, it leads to better clinical outcomes.’

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Dr Harry Imber   10/07/2019 8:25:09 AM

This excellent article shows---YET AGAIN---that seeing one regular GP for everything (incl. so-called minor matters) is critical. Seeing multiple Dr's is not good
for your health. Younger people seem to not get,or understand,the importance of thisThe RACGP should make public statements on this.

Dr Ruth Helen Gawler   10/07/2019 10:20:08 AM

What a wonderful article! So true my own experience as a GP for over 35 years....well done for stating it so clearly!

John B Dixon   10/07/2019 5:12:41 PM

Nothing new here. There is clear evidence that shaming and blaming those living with obesity increases risks and disengages them from receiving appropriate care. Doctor come second to families in generating weight stigma.

Dr Mark Frederick Fletcher   10/07/2019 8:55:40 PM

I suspect that there are enormous confounders in this study, as per usual. This is a very subjective aspect of healthcare. I would suggest what is most important is not necessarily empathy, but rather trust and respect. Listen to the history, let people talk, be thorough but most of all, be objective. It's not about people's feelings. It's about facts.

Chris D Hogan   11/07/2019 10:05:20 AM

There is a flip side to this with evidence ( particularly for surgeons) that patients with non empathetic doctors do worse