types of doctor specialties :: Article CreatorHigh Physician Empathy Could Offer Patients With Lower Back Pain Lasting Benefits, Study Shows
Amid the many demands of practicing medicine, doctors can have less time and energy for their patients, and those relationships can suffer. Yet research has shown that when physicians show empathy, that can generally lead to better clinical outcomes, at least over the near-term. Now, a new study, published Thursday in JAMA Network Open, demonstrates that those benefits can extend longer and be even more effective than some clinical therapies in dealing with lower back pain, which affects half of the U.S. Population in any given year.
Researchers at the University of North Texas Health Science Center at Fort Worth, observing patients with lower back pain over the course of 12 months, found that treatment by a "very empathic" physician was associated with better outcomes at the end of that year than treatment by a "slightly empathic" physician. And those positive outcomes were greater than those associated with nonpharmacological treatments (exercise therapy, yoga, massage therapy, spinal manipulation, acupuncture, cognitive behavioral therapy), opioid therapy, and lumbar spine surgery.
"Nobody's done any real long-term studies, such as the one that we've done here for 12 months," said John Licciardone, Regents professor of family medicine at University of North Texas Health Science Center and the first author of the study. What he found most surprising is that "empathy is associated with better outcomes, but they're also outcomes that really appear to last for a long period of time."
Lower back pain is a very common condition, with 619 million people affected globally in 2020 according to the World Health Organization. In the U.S., up to 85% of people experience some form of back pain during their lifetime, and 50% have recurrent episodes within a calendar year. Licciardone and his colleagues turned to data from the nationwide Pain Registry for Epidemiological, Clinical and Interventional Studies and Innovation (PRECISION) and employed an empathic scoring system known as CARE, or Consultation and Relational Empathy. Run through the University of North Texas Health Science Center, the registry enrolls volunteers with chronic lower back pain between 21 to 79 years old.
"I think that it's elegant," Shiqian Shen, a pain management physician at Massachusetts General Hospital and Harvard Medical School, said about the study. He added that while it might seem like common sense, "real patient contact with compassionate or passionate care is something that is not being emphasized enough."
Focusing on people with lower back pain made sense, he added. "I think that's part of one reason this patient population is being studied because it's easier to gather enough patients to see a signal," said Shen, who was not involved in the study.
Researchers used the data from 1,470 study participants drawn from the PRECISION registry who answered a set of 10 questions focused on patients' opinions about their doctors. For example, did their doctor make them feel at ease? Did they explain things clearly and show care and compassion? From those questions, the researchers rated a doctor as "very empathic" or "slightly empathic."
After looking at patient-reported outcomes based on their level of pain and their ability to function, researchers found that, across the board, patients who had very empathic doctors had scores that reflected that they had less pain, were less likely to feel depressed, and less likely to have anxiety or other conditions that might interfere with their quality of life.
While Licciardone said that the data suggests a strong correlation between having a physician with high levels of empathy and experiencing better outcomes, Shen pointed out that there was only a moderate effect on improved health outcomes in the study. He said, nonetheless, that practicing empathy is "something that we ought to do anyway, so we still have to improve on that aspect."
Shen added that the results of this research suggest that physicians should look beyond the biological underpinnings of disease. Sometimes there are psychological factors and social factors that contribute to how a patient interprets their pain. "So, if we address only the biological aspect, by putting needles, doing the surgeries, … we might actually miss some opportunities to improve patient care."
Lisa Hanrahan, a patient at the Pain Management Center at Mass General who leads the medical assistants team at the hospital, receives an injection every six months for her lower back pain. She told STAT that she feels comfortable because her medical team makes sure that she's OK and not feeling pain, and she appreciates how they carefully explain procedures to her with the help of models and diagrams. Shen is one of Hanrahan's providers.
Licciardone and Shen believe that this study can be generalized to patients suffering from chronic pain and other chronic conditions. Ted James, chief of breast surgery at Beth Israel Deaconess Medical Center in Boston who was not a part of this study, stressed that the physician-patient relationship can be important across all specialties. Licciardone said one limitation of the study is that patients' thoughts about their physicians didn't really change over the course of 12 months. This means that patients who had very empathic physicians always started out with better outcomes than those who had slightly empathic physicians. Designing a randomized controlled study would have been difficult, but Licciardone and his colleagues hope to conduct a new type of study called a target trial emulation study, which imitates a clinical trial.
James, who has written about building physician empathy, added that while it's hard to control for things in this type of observational study, it still shows the importance of the initial rapport that a physician has with their patient. He added that "empathy goes beyond being nice" — it is a skill that should be developed and a tool that clinicians should use.
Licciardone noted that researchers only conducted the study in English, which limited the diversity of the respondents. While this study did not look at sociodemographics, Licciardone said a 2022 study published in JAMA Network Open, showed that Black patients actually reported their doctors had higher empathy levels than white patients reported for their doctors, which he said he found a bit surprising.
All physicians who STAT spoke with mentioned that physicians should take more time to treat their patients as human beings, and that empathy should be emphasized while students are learning and throughout their professional careers.
"I feel very lucky … thankfully this was really emphasized by the majority of my teachers and so I think that really got ingrained in me," said Stephanie Van, an interventional pain management specialist at Johns Hopkins School of Medicine and an assistant professor. She added that she always tells her students to humanize their patients and to never forget to ask about what they do for a living or what their favorite hobbies are. Because then that person with back pain becomes the grandma who wants to get back to playing with her grandchildren and knitting. "That's a simple practice change that can really help humanize someone's patients and help them see them as a whole person," she said. Van, who is also a disability advocate, hopes to see more questionnaire-based studies about how patients feel about their access needs.
Shen said that doctors who treat chronic conditions should take these results into consideration when interacting with patients. "Sometimes they're not asking for a magic cure, magic needle, magic knife," said Shen. "What they care for is they want to be heard, and they want to be understood. And there was someone to help them along the way."
Multiple Myeloma
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Multiple myeloma is a rare type of cancer. It starts with the uncontrolled production of plasma cells. These are a type of white blood cell in the bone marrow.
Healthy plasma cells make antibodies that help fight infection. But the myeloma plasma cells make abnormal antibodies. This can make it hard for your body to fight infection. And when there are too many plasma cells, they can crowd out normal blood cells. This can cause anemia and increased bruising or bleeding.
The plasma cells can collect in the bone to form small, painful tumors. These tumors can lead to broken bones. The plasma cells and the abnormal antibodies can also cause problems with the kidneys.
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What Causes Multiple Myeloma?
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The exact cause of multiple myeloma is not known. Changes (mutations) in the DNA of your cells may play a role. These changes may prompt your body to start creating too many plasma cells and abnormal antibodies.
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What are the Symptoms of Multiple Myeloma?
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Common symptoms of multiple myeloma include bone pain and broken bones. You may also have weakness or fatigue. You could have frequent infections, fever, pneumonia, numbness, or kidney failure. You may bruise or bleed easily. Some people have no symptoms in the early stages of myeloma.
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How is Multiple Myeloma Diagnosed?
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Your doctor will do a physical exam and talk with you about your current symptoms and past health. Your doctor will also do several tests, such as:
Blood tests: These are used to look at the levels of red and white cells in your blood. Some tests check for abnormal antibodies in the bloodstream. Urine tests: These check to see how well your kidneys work. They are also used to look for signs of multiple myeloma. Imaging tests: These may include X-rays, MRIs, CT scans, or PET scans. They can show broken bones, bone tumors, or other problems with your bones. Bone marrow biopsy: This test is used to look for the amount of cancer cells in your bones. Sometimes myeloma is found by chance in people who have no symptoms of this cancer. This can happen when they get one of these tests for another reason.
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How is Multiple Myeloma Treated?
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Multiple myeloma that isn't causing symptoms may not need treatment right away. If you need treatment, it may include:
Chemotherapy: These medicines kill fast-growing cells like cancer cells. Radiation therapy: This uses high-dose X-rays to destroy cancer cells and shrink tumors. Steroid medicines: These can help treat myeloma and help with treatment side effects, such as pain and swelling. Targeted therapy: These medicines attack only cancer cells, not normal cells. They help keep cancer from growing or spreading. Stem cell transplants: This replaces damaged cells with healthy stem cells. They help your bone marrow make healthy blood cells. Immunotherapy: This treatment helps your immune system fight cancer. It may be given in several ways. Bone-modifying agents: These medicines make bones stronger. This helps prevent fractures and reduces bone pain. Bone tumors caused by multiple myeloma may be treated with medicines, radiation, and surgery.
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How Can You Care for Multiple Myeloma?
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Tell your doctor if you are experiencing new pain, or pain that interferes with your daily activities. Do not try to "tough it out." Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine. You may get medicine for nausea and vomiting if you have these side effects. Eat healthy food. If you do not feel like eating, try to eat food that has protein and extra calories to keep up your strength and prevent weight loss. Drink liquid meal replacements for extra calories and protein. Try to eat your main meal early. Get some physical activity every day, but do not get too tired. Keep doing the hobbies you enjoy as your energy allows. Take steps to control your stress and workload. Learn relaxation techniques. Share your feelings. Stress and tension affect our emotions. By expressing your feelings to others, you may be able to understand and cope with them. Consider joining a support group. Talking about a problem with your spouse, a good friend, or other people with similar problems is a good way to reduce tension and stress. Express yourself through art. Try writing, crafts, dance, or art to relieve stress. Some dance, writing, or art groups may be available just for people who have cancer. Be kind to your body and mind. Getting enough sleep, eating a healthy diet, and taking time to do things you enjoy can contribute to an overall feeling of balance in your life and can help reduce stress. Get help if you need it. Discuss your concerns with your doctor or counselor. If you are vomiting or have diarrhea: Drink plenty of fluids (enough so that your urine is light yellow or clear like water) to prevent dehydration. Choose water and other caffeine-free clear liquids until you feel better. If you have kidney, heart, or liver disease and have to limit fluids, talk with your doctor before you increase the amount of fluids you drink. When you are able to eat, try clear soups, mild foods, and liquids until all symptoms are gone for 12 to 48 hours. Other good choices include dry toast, crackers, cooked cereal, and gelatin dessert, such as Jell-O. If you have not already done so, prepare a list of advance directives. Advance directives are instructions to your doctor and family members about what kind of care you want if you become unable to speak or express yourself. © 2016-2020 Healthwise, Incorporated.
Types Of Breast Cancer
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Breast cancer is the growth of abnormal cells in the ducts or lobes of the breast. Breast cancer may be either:
Invasive
This means cancer has spread from the ducts or lobes into normal breast tissue. The main invasive types are:
Ductal carcinoma: This cancer starts in the ducts of the breast. It's the most common type of breast cancer. Lobular carcinoma: This cancer starts in the lobes of the breast. It's the second most common type. Some breast cancer is a mix of ductal and lobular carcinoma. Other less common invasive types include inflammatory breast cancer and male breast cancer.
Noninvasive This means the abnormal cells haven't spread beyond the ducts or lobes. These cancers include:
Ductal carcinoma in situ (DCIS): In this type, the abnormal cells are only in the ducts of the breast. (Lobular carcinoma in situ [LCIS] is not considered to be cancer.) Paget disease of the nipple: The abnormal cells are only in or around the nipple. This is a rare type of cancer. After the type of cancer is known, the cancer cells are checked for estrogen receptors, progesterone receptors, and large amounts of a protein called HER2. This information helps a doctor plan the treatment.
If the cancer cells don't have these three traits, they are called "triple-negative." Triple-negative breast cancer is a less common type of invasive breast cancer.
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