Two weeks ago, I was a faculty participant in the first international conference on Mental Health and Diabetes held in Philadelphia. The conference concentrated on methods to improve behavioral health in people with diabetes and was the first to include and enable two disciplines (psychology and medical health care providers) to network together in close proximity. The conference was spearheaded by Lee Ducat, the original founder of JDRF and led by internationally recognized adult and pediatric diabetologists/endocrinologists and psychologists. At the conclusion of the conference, concrete plans were initiated to move forward in recognizing the importance of mental health and the rapid mental health screening methods that health care providers apply with their patients. And, if there were any red flags denoting issues, referral to a mental health professional is in order.
Thus, upon returning home to Washington, D.C. and seeing my patients, I was even more cognizant of the importance of communication, expectations, and un-verbalized messages that I might have missed. In addition, one of our hospital’s main objectives is to improve patient experience and satisfaction with our health providers. Thus, in the qualitative research study , “Nonverbal Interpersonal Interactions in Clinical Encounters and Patient Perceptions of Empathy,” published in the Journal of Participatory Medicine (vol 5, 2013, August 14, 2013), Montague, Chen, Chewning, and Barrett were interested in exploring the relationship between nonverbal communication behaviors (eye contact and social touch) and patient perceptions of clinicians (empathy, connectedness, and liking).
Study Method: “Clinician and patient nonverbal behaviors were coded temporally in 110 videotaped clinical encounters.” The participants completed questionnaires to determine their perceptions of:
1. clinician empathy
2. clinician connectedness
3. how much they liked their clinician.
These questionnaires measured the patient’s perception of the clinicians’ empathy using the CARE instrument which has been qualitatively and quantitatively validated and has shown good reliability, necessary attributes for a questionnaire to denote statistical significance.
What were the results?
- Length of visit and eye contact between patient and physician were positively related towards the assessment of clinician empathy.
- Social touch and eye contact were related and significantly related, respectively to patient perception of physician connectedness and liking.
How might we practically apply these findings during our routine diabetes follow-up visits, knowing that we are time limited?
As diabetes is a chronic illness, there is an important and significant relationship between the patient/family and health care team. After 30 years of experience caring for children and adolescents with diabetes, it has become very clear that in order to improve health outcomes, there must be a therapeutic alliance between the clinician and family. Surprisingly, there has been little research documenting the non-verbal cues that accompany content that is delivered in the office visit. It is now clear that in order for important content to be effectively delivered, the clinician must do more than just “deliver it with words.” Clearly, hb A1c levels are determined by many variables; however, the relationship between provider and family is an important one. There are major limitations to this study in terms of the time element. Clinicians are constantly being asked to see more patients in less time. What about the use of technology by which we are entering data into our computers and spending less time face to face with patients? Does this make a difference in outcomes?
If we can do our best to maximize the time we have with our patients given the current constraints and deliver the therapeutic content in the most empathetic manner possible with concerned eye contact and caring touch, will that improve health outcomes? Does liking your physician, and physician connectedness improve hb A1c, glycemic status, and reduce complications?
What are your thoughts?
Published On: October 21, 2013