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Does bedside manner make a difference in patient outcome?

Robin Wulffson MD's picture
diabetes, bedside manner, physician empathy, outcome

All physicians in the United States must meet high standards to be licensed to care for patients.

However, physicians vary in empathy. It is not uncommon to hear the statement, “He’s rather gruff, but he is a good doctor.” According to a new study, Dr. Gruff may not be the best choice. An international team of researchers published their findings regarding physician empathy in the September issue of the journal Academic Medicine.

The aim of the study was to test the theories that scores of a validated measure of physician empathy are associated with clinical outcomes for patients with diabetes. The study group comprised 20,961 patients with type 1 or type 2 diabetes from a population of 284,298 adult patients in the Local Health Authority, Parma, Italy. The patients, who were under the care of one of 242 primary care physicians for the entire year of 2009, were retrospectively analyzed. To measure physician empathy, the investigators mailed the physicians a validated method of measurement called the Jefferson Scale of Empathy (JSE). The JSE includes 20 items that measure how well a healthcare professional understands the patient's perspective. Available in 42 languages, the JSE has been used in the United States and internationally. The physicians’ Jefferson Scale of Empathy scores were compared with occurrence of acute metabolic complications (hyperosmolar state, diabetic ketoacidosis, coma) in diabetes patients hospitalized in 2009.

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The physicians with high scores had 7,224 patients with diabetes, the moderate scorers had 7,303 patients with diabetes, and the low scorers had 6434 patients with diabetes. Of the 242 physicians, 81 who completed the JSE were high scorers (range: 112 to 137); this indicated a high level of empathy. Moderate scores (range: 97 to 111) were attained by 84 physicians, and 77 physicians were low scorers (range: 49 to 96).The researchers found that patients of physicians with high empathy scores, compared with patients of physicians with moderate and low empathy scores, had a significantly lower rate of acute metabolic complications per 1,000 patients (high score: 4.0; moderate score: 7.1; low score: 6.5).

Patients aged 69 or older also contributed to the prediction of acute metabolic complications. Physicians’ gender and age, patients’ gender, type of practice (solo, association), geographical location of practice (mountain, hills, plain), and length of time the patient had been enrolled with the physician were not associated with acute metabolic complications.

The researchers concluded that their results suggest that physician empathy is significantly associated with clinical outcome for patients with diabetes mellitus and should be considered an important component of clinical competence.

Take home message:
This study describes the health advantage of having receiving ones care from a physician with empathy. In today’s medical environment, many physicians have a high volume practice in which empathy may fall by the wayside. However, many still try to maintain an empathetic relationship with their patients. After assessing a prospective physician’s qualifications, try to outside his or her bedside manner. If possible, attempt to obtain input from other patients. This should be accomplished before your visit. It also can be accomplished via a discussion with other patients in the waiting room.

Reference: Academic Medicine