UVM Integrative Lecture Series: “The Clinician Effect: How Human Connection Impacts Outcomes”
Lecture Type: Online Video (Link Here)
Time: 60 minutes 53 seconds
Date: September 26, 2016
Speaker: David Rakel, M.D.
Topic: The Clinician Effect
Introduction
Dr. David Rakel, M.D., presents a talk on the clinician effect for the University of Vermont Laura Mann Integrative Lecture Series. Dr. Rakel is a professor and chair of the Department of Family & Community Medicine at the University of New Medico School of Medicine. He completed a residency in Family Medicine and a subspecialty in non-surgical Sports Medicine. He has researched the positive impacts of compassionate care and how this can improve the health outcomes for patients.
You can view the lecture on YouTube by clicking the link here.
You can download the PowerPoint presentation for this lecture by clicking the link here.
By far the most frequent drug used in general practice was the doctor himself. It was not the bottle of medication or the box of pills that mattered but the way the doctor gave them to his patients.
Michael Balint in Introduction for the Doctor, His Patient and the Illness (1957, p. 1)
Medical Care Today
Dr. Rakel explains the current state of medical care and training today. Described as conventional linear medicine, doctors are trained to assess symptoms, determine a diagnosis of pathogenesis, and prescribe treatment, usually in the form of medication. The goal is to return the patient to their original state. In this process, the patient is usually passive. Standard delivery of care may lack emotion on part of the physician and is often very short in duration, which does not allow patient input into their plan of care in a meaningful way.
There are additional challenges with this approach to care, particularly regarding treating psychiatric conditions, and chronic medical conditions like diabetes and chronic pain. For example, research on Medicare costs to treat chronic pain by Dayo and colleagues (2009) shows that despite a 629% increase in epidural injections (a common steroid injection that treats joint pain by decreasing inflammation) over 10 years there was no improvement in pain or disability over time. Dr. Rakel explains that this method of care is based on the volume of treatment, which increases the cost of care.
Despite these challenges, there is a growing body of research that shows that conventional medicine can be transformed to address these issues in innovative ways. Working within the system, doctors can provide integrative medicine to improve health outcomes for all people.
An Integrative Approach to Care
Integrative medicine is an approach to care to improve the health and resiliency of patients. It incorporates evidence-based therapies that are not typically included in conventional medicine today, such as acupuncture. These safe and effective therapeutic approaches are often matched to the individual’s culture, beliefs, and preferences. It also includes a more holistic view of the patient, incorporating nutrition, physical activity, sleep, environmental protection factors, personal development, spiritual and social community, and emotional and mental balance. It acknowledges and seeks to address the complexity of patients to promote salutogenesis, or the creation of health, rather than a sole focus on pathogenesis or disease.
Dr. Rakel describes integrative medicine as circular. It is a collaborative process between patient and physician that focuses on empowering patients to take control of their well-being through meaningful therapies to obtain a new state. A relationship is built between patient and provider based on trust, unconditional positive regard, and reciprocity. Trust is based on intimacy (the relationship between patient and provider) and competency (the medical knowledge of the provider). Without either, the relationship falls apart. Dr. Rakel calls this compassionate care, which has been shown to be a powerful force for healing.
The Clinician Effect
As described by Dr. Rakel, the clinician effect is the clinical impact that a healthcare provider creates simply by the way they interact with their patients. When doctors provide compassionate care, there are improvements in health outcomes. For example, in two studies by Rakel and colleagues (2009 and 2011), patients treated with “enhanced care” using more empathetic language were shown to have decreased severity and length of symptoms of a common cold. Surprisingly, patients were also shown to have slightly better outcomes if they did not go to the doctor at all compared to those who visited the doctor and received standardized care. However, I want to note that only one p-value was given for all results and the latter findings may not be clinically significant. You can view the data presented in Dr. Rakel’s presentation below. Overall, this displays the impact that doctors make on healthcare outcomes simply by the way they interact with their patients.
Healthcare providers across the United States are beginning to recognize the importance of the clinician effect. The Veteran’s Health Administration (VHA) initiated a personalized, proactive, patient-driven focus to care. Utilizing methods taken from motivational interviewing that connect meaning to health behaviors, as well as incorporating meaning through spirituality, VHA doctors are trained to ask three questions. These are:
- What do you want your health for?
- Whare areas do we need to work on?
- How can we help you get there?
These questions focus on patients’ values and help to create an organizational transformation to promote compassionate person-centered care.
Dr. Rakel also explains how the mnemonic PEECE can also be used to guide providers to enhance their compassionate care skills. PEECE stands for:
- P – Positive prognosis: Focusing on patient’s positive health outcomes that they can work towards.
- E – Education: Explaining to patients their diagnosis, treatment options, and plan going forward.
- E – Empowerment: Encouraging patient participation in their care decisions and utilizing lifestyle change.
- C – Connection: Focusing on how the patient feels.
- E – Empathy: Showing compassion and taking action to address suffering.
Concluding Thoughts
Doctors themselves can affect the health outcomes of their patients simply by providing compassionate care. The foundation of this is human connection. Dr. Rakel explains when this is combined with integrative medicine and conventional care it can be a powerful force to improve medical outcomes.
You can view the lecture on YouTube by clicking the link here.
You can download the PowerPoint presentation for this lecture by clicking the link here.
Citation
Rakel, D. (2016, September 26). The Clinician Effect: How Human Connection Impacts Outcomes. [Lecture Recording]. University of Vermont Laura Mann Integrative Health Care Lecture Series. https://www.youtube.com/watch?v=Wc6x35BzjDs
Disclaimer
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