Empathy: The First Step To Improving Health Outcomes

A Health Affairs post points to a study that higher levels of physician empathy predicted better outcomes for diabetes patients.

A 2012 study from Italy analyzed the health outcomes of more than 20,000 patients with diabetes, who were assigned to three different groups of physicians (pre-evaluated for their levels of empathy). The physicians who demonstrated the highest degrees of empathy achieved the best results with their patients; the patients had statistically significant lower levels of diabetic complications than the groups whose physicians had scored lower in empathy.

It makes a lot of sense that this would be especially important in chronic disease management (or, recovery management) , where the goal is long term engagement to monitor their illness/recovery, support the patient through difficult behavioral changes and re-intervene quickly when symptoms recur.

Who would want to call their helper about problems in their recovery or a relapse? This isn’t an easy call to make under the best circumstances. Even more so if you don’t believe your helper understands, cares or worse, judges you. Under these circumstances the patient is more likely to put it off and put it off as the problem grows and becomes more difficult to manage.

I continue to be convinced that addiction treatment providers have a lot to learn from chronic disease management and that we have a lot of experience to offer them. This will be important to follow as the chronic disease burden continues to get more attention.

via Empathy: The First Step To Improving Health Outcomes – Health Affairs Blog.

Less effective and focused on only one problem

Some friends shared this video about the benefits of exercise:

At about 7:00, he says:

So a German researcher named Rainer Hambrecht looked at this with about 100 cardiac patients He got the group to exercise, and by that I mean 20 minutes a day in an exercise bicycle and once a week a 60 minute aerobics class, and the other half got the high tech stent and just did their normal activity, and after one year 88% of the exercise group were event free, compared to 70% of the people who got a Stent. So both worked, but I find it sort of incredible that the low tech made a bigger difference and you have to remember that the Stent just fixes one part of the heart.

Earlier, he outlined the diverse benefits of physical activity in various populations, including:

• [in knee arthritis patients, it] reduced rates of pain and disability by 47%
• reduced progression to dementia and Alzheimer’s by around 50%
• reduced progression to frank diabetes by 58%
• 41% reduction on the risk of hip fracture
• reduced anxiety by 48%
• 23% lower risk of death
• number one treatment of fatigue
• shown again and again to improve qualty of life

This got me thinking about whether12 step recovery is to addiction what exercise is to heart disease.

Preventing heart attacks is a very good thing. That stents exist and are readily available is a very good thing. This sounds like a very strange thing to wonder, but would we be better off it cardiac care was a little less medicalized? If there was a little more parity in research and resources invested in helping people be more physically active? I know that there are some efforts in this direction, but is the medical system missing the boat?

In the same way we have interventions (like medications) that can prevent overdose and reduce drug use. But, these offer none of the other benefits. Further, the damage done by addiction is often pretty global—physical, emotional, social, familial, spiritual, occupational, educational, etc. So…an intervention narrowly focused on drug use is, at best, a start on the path to wellness and recovery.

Of course we can’t make cardiac patients exercise and we shouldn’t withhold care to patients who do not exercise or give them second class care. But, maybe, the medical system should be more focused on “recovery” rather than just harm reduction?

The addiction treatment system did a lousy with people who didn’t engage in our version of exercise, we didn’t do a good job supporting it beyond a period of a few weeks or months, we sometimes used some dubious and even harmful methods to get people to do it. (We’re not alone in this. Medical history is full of dubious and harmful methods.) But…there’s been a lot of improvement, a lot of success and it offers global benefits that go well beyond abstinence or reduced drug use. So…why are so many people in a hurry to abandon and dismantle this system?