Does Your Doctor ‘Get You’?

Does your doctor understand you? Does he (or she) know what you’re thinking? Does he really feel your pain? In short, does he care?

Seems this is something you should really care about. According to a study just published in Academic Medicine, patients of doctors who are more empathic have better outcomes and fewer complications.

Researchers from Thomas Jefferson University together with a team from Parma, Italy evaluated relationships between physician empathy and clinical outcomes among 20,961 Italian diabetic patients and their 242 physicians.

The study was a follow up to a smaller one undertaken at Thomas Jefferson University that included 891 diabetic patients and 29 physicians, and showed that patients of physicians with high empathy scores had better clinical outcomes than patients of other physicians with lower scores.

This new, large-scale research study has confirmed that empathic physician-patient relationships is an important factor in positive outcomes,” said Mohammadreza Hojat, Ph.D., Research Professor in the Department of Psychiatry and Human Behavior and the Director of Jefferson Longitudinal Study at the Center.  “It takes our hypothesis one step further. Compared to our initial study, it has a much larger number of patients and physicians, a different, tangible clinical outcome, hospital admission for acute metabolic complications, and a cross-cultural feature that will allow for generalization of the findings in different cultures, and different health care systems.”

The Italian researchers used the Jefferson Scale of Empathy (JSE) –an instrument used to measure empathy in the context of medical education and patient care. The JSE includes 20 items answered on a seven-point scale (strongly agree = 7, strongly disagree = 1) and measures understanding of patient’s concerns, pain, and suffering, and an intention to help.

The primary outcome measure of the study was acute metabolic complications, including hyperosmolar state, diabetic ketoacidosis, and diabetic coma. These were used because they require hospitalization, can develop quickly, and their prevention is more likely to be influenced by the primary care physicians.

A total of 123 patients were hospitalized because of such complications. Physicians with higher empathy levels had 29 : 7,224 patients admitted to the hospital, whereas physicians with lower levels had 42 : 6,434 patients admitted.

There are many factors that add to the strength of the study. Firstly, because of universal health care coverage in Italy, there is no confounding effect of difference in insurance, lack of insurance or financial barriers to access care.

What’s more, this study was conducted in a health care system in which all residents enroll with a primary care physician resulting in a better defined relationship between the patients and their primary care physicians than what exists in the United States,” said co-author Daniel Z. Louis.

According to the Centers for Disease Control and Prevention, over 25 million people in the U.S. population have been diagnosed with diabetes, with almost 700,000 hospitalizations per year. There are approximately 2 million new cases per year. Worldwide, the number of total cases jumps to 180 million.

Results of this study confirmed our hypothesis that a validated measure of physician empathy is significantly associated with the incidence of acute metabolic complications in diabetic patients, and provide the much-needed, additional empirical support for the beneficial effects of empathy in patient care” said Dr. Hojat. “These findings also support the recommendations of such professional organizations as the Association of American Medical Colleges and the American Board of Internal Medicine of the importance of assessing and enhancing empathic skills in undergraduate and graduate medical education.”

Does your doctor get you? Let us know.

Nurse Practitioners Ready to Mind the Gap

Obamacare’ is expected to expand health insurance to 32 million Americans over the next decade. This will inevitably lead to a spike in demand for medical services; leading many people to wonder who will provide that care. Maybe we need to wonder no more.

As you read this post, nurse practitioners (NPs) are throwing their hats in the ring and gearing up to be among the front runners.

Through advertisements, public service announcements and events, the American Academy of Nurse Practitioners (AANP) will try to raise the profile of the country’s 155,000 nurse practitioners.  Their campaign aims to explain exactly what nurse practitioners do and why patients should trust them with their medical needs.

AANP will also exploit the very real, looming doctor shortage. According to the Association of American Medical Colleges  the country will have 63,000 too few doctors by 2015.

With the serious shortage of family doctors in many parts of the country, nurse practitioners  will claim, in a series of radio public service announcements, that they can provide expert, compassionate and affordable care. The AANP will follow up on the public relations blitz with state-level lobbying efforts, looking to pass bills that will expand the range of medical procedures that their membership can perform.

A fully enabled nurse practitioner workforce will increase access to quality health care, improve outcomes and make the health-care system more affordable for patients all across America,” ­ says Penny Kaye Jensen, president of the AANP. “It is our goal to empower health care consumers in all 50 states with clear confirmation that NPs provide professional, compassionate and cost-effective primary health care, as we have done for more than forty years.”

In 16 states, “scope of practice” laws allow nurse practitioners to practice without the supervision of a doctor. Other states, however, require a physician to sign off on a nurse practitioner’s prescriptions, and/or diagnostic tests.

As the health insurance expansion looms, expanding those rules to other states has become a crucial priority for NPs. “We’re all educated and prepared to provide a full range of services,” said Taynin Kopanos, AANP’s director of state government affairs.

The nurse practitioners’ campaign, however, is unlikely to move forward without a fight. Physician groups, such as the American Medical Association (AMA), contend that such laws could put patients at risk and oppose the efforts of other professional societies to expand their medical authorities.

Nurse practitioners argue that they do have the skills necessary to treat patients with more autonomy. Unlike other nurses, all nurse practitioners hold either a master’s or doctorate degree in medical education.

Alongside the legislative push, the group also will focus on public education. Data suggest that they have their work cut out for them.

A 2010 AANP poll found that while most Americans report having been seen by a nurse practitioner, few knew that their medical expertise goes beyond that of traditional, registered nurses.

Only 14% of the adults surveyed thought that nurse practitioners could prescribe medication, an authority they have in all states and only 18% thought NPs could order diagnostic tests such as X-rays and MRIs.

People stop at the word nurse and don’t understand the word practitioner,” Jensen said. “Obviously we are nurses, but we also have advanced education. We think there’s a misunderstanding on the patients’ behalf.”

Lend your voice to the healthcare debate by sharing with us your thoughts on NPs, their visibility, their scope of practice and their role in the healthcare of our nation.

More Guidelines on Pharma – Physician relationships

A recent report issued by the Association of American Medical Colleges (AAMC) urges teaching hospitals to establish policies to manage financial relationships between physicians and the pharmaceutical industry so that they do not influence patient care.

The report entitled, In the Interest of Patients: Recommendations for Physician Financial Relationships and Clinical Decision Making is the work of a task force convened by the AAMC in 2009.  It provides guidance on how academic medical centers can identify, evaluate and disclose conflicts of interest in clinical care. In its favor, the report points out that partnerships between academic medical centers and industry are essential to innovation and create powerful collaborations that benefit all patients. However, it warns that the presence of individual or institutional financial interests in these relationships may create perceived or real conflicts of interests in patient care.

Because patients and the health of the public are top priorities for the nation’s medical schools and teaching hospitals, we must uphold the highest standards of professionalism, while maintaining principled relationships with industry to improve patient care,” said AAMC Chief Health Care Officer Joanne M. Conroy, M.D.

Although many academic medical centers already have conflict of interest (COI) policies that govern research and corporate relationships, only a small number of these institutions have adopted policies that define and address conflicts of interest in clinical care.

To help academic medical centers develop guidelines, the report suggests that institutions first evaluate their own compensation systems to determine whether they influence physician behavior and conflict with the best interest of patients.

The report also recommends that academic medical centers:

  • Establish mechanisms to identify physician-industry financial relationships and evaluate their potential to bias the clinical decision-making of physicians
  • Consider payments for services, royalties, and ownership when assessing individual related financial interests
  • Set thresholds for physician reporting and institutions’ evaluation of reported interests
  • Make available to their patient communities and the public information on the industry relationships of their physicians, their value, and efforts to mitigate any bias resulting from these relationships
  • Involve patients to help them to determine what information about physician-industry ties is useful and how it should be presented to specific patient groups

As a follow up to the report, the AAMC is developing clinical scenarios that can be used by its members to help define their approach to addressing conflicts of interest in patient care.

SRxA’s Word on Health welcomes these guidelines and is pleased to see that we are now talking about “managing relationships” with the pharmaceutical industry rather than banning them altogether.  Placing the onus on physicians rather than putting punitive prohibitions on pharma is probably a win-win for both sides.