Doctors Are Crucial in
Improving Your Health

(HealthScout) -- Want to improve your health? Have a heart-to-heart talk with your doctor.

Patients who feel they're getting emotional reinforcement from their physicians report better outcomes for a variety of illnesses, a new British study shows.

Scientists have long known that the way a doctor presents information to patients can be as important as the information itself. This so-called "context effect" involves "cognitive" care, which establishes patient expectations about the effectiveness of a given treatment, and "emotional" care, which classifies a doctor's demeanor as warm, cold, reassuring or flatly clinical.

The quality of the relationship "absolutely" affects outcomes, says Marilyn Yager, executive director of the Kenneth B. Schwartz Center, a Boston-based nonprofit group that studies doctor-patient communication issues.

Good doctor-patient communication improves compliance with treatment regimens, which is important to recovery, and reduces medication errors, Yager says. Doctors who have a good rapport with their patients also are less likely to be sued by them should something go wrong, a key to minimizing litigation costs.

"These sorts of issues used to be seen as touchy-feely. They've now become money issues," Yager says.

In the latest study, reported in the March 10 issue of The Lancet, Zelda Di Blasi, a doctoral student in health psychology at the University of York in England, and her colleagues analyzed 25 previous studies of the impact of doctor-patient communication on health outcomes.

Most of the studies looked at how a patient's expectations influenced how well treatment worked for them -- the so-called placebo effect. The illnesses involved common conditions, including pain, high blood pressure and obesity, and the outcomes were short-term measures of success, not long-term gauges or mortality.

Of 19 studies that tracked how doctors influenced patient expectations of treatment, 10 showed that doctors who were encouraging about care could improve at least some measures of success. Yet Di Blasi's team says most of these studies weren't very well done, while five of the nine that found no effect were either good or very good.

None of the studies addressed only emotional care; however, four studies assessed the combined effect of emotional and cognitive care on patient outcomes. And in three of these, patients who received positive emotional feedback appeared to do better than those in which doctors were more stiff or formal, as measured by self-reported pain, time of recovery, blood pressure and heart rate, Di Blasi says.

While how emotional bonding with doctors helps patients is not clear, Di Blasi says a strong "therapeutic alliance" helps people become more relaxed about their care. Similarly, if they trust their physicians, patients are more likely to believe that the treatment they get will help, she says.

Physicians should exude as much confidence as appropriate about what they're prescribing, she says. "If the doctors don't believe that the treatment is effective, the patients can pick that up, and it's less likely to have an effect," Di Blasi says.

But the office visit is shared time. "The patient also has the responsibility to maximize the time they have with their practitioners," Di Blasi says. "They also are an expert in what's happening to them," and can transmit information vital to their care.

Patients can foster an emotional bond with their doctors by continuing to see them, writes Dr. Chris van Weel of the University Medical Center St. Radboud, in the Netherlands, in an editorial accompanying the journal article.

"The continuity of care by one person over time strengthens the trust between patient and practitioner and enables the doctor to accumulate knowledge of the patient's personal and family circumstances," van Weel writes.

If you're not satisfied with interactions with your doctor, consider switching to someone with whom you feel more comfortable, Di Blasi says. It might improve your health.

To learn more about the doctor-patient relationship, visit the Kenneth B. Schwartz Center.

For more on health communication, try the Community & Public Health Administration of Maryland.

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