Is Physician Empathy Associated With Differences in Pain and Functional Limitations After a Hand Surgeon Visit?

• Published in: Clinical orthopaedics and related research 2018-04, Vol.476 (4), p.801-807
• Main Authors: Kootstra, Thomas J M, Wilkens, Suzanne C, Menendez, Mariano E, Ring, David
• Format: Article
• Language: English
• Subjects: Adaptation, Psychological; Adult; Aged; Aged, 80 and over; Attitude of Health Personnel; Empathy; Female; Hand - physiopathology; Hand - surgery; Health Knowledge, Attitudes, Practice; Health Status; Humans; Male; Mental Health; Middle Aged; Musculoskeletal Pain - diagnosis; Musculoskeletal Pain - physiopathology; Musculoskeletal Pain - psychology; Musculoskeletal Pain - surgery; Office Visits; Orthopedic Surgeons - psychology; Pain Measurement; Patient Reported Outcome Measures; Physician-Patient Relations; Prospective Studies; Symposium: Comprehensive Orthopaedic Care; Young Adult
• ISSN: 0009-921X; 1528-1132; 0009-921X
• DOI: 10.1007/s11999.0000000000000077

In prior work we demonstrated that patient-rated physician empathy was the strongest driver of patient satisfaction after a visit to an orthopaedic hand surgeon. Data from the primary care setting suggest a positive association between physician empathy and clinical outcomes, including symptoms of the common cold. It is possible that an empathic encounter could make immediate and measureable changes in a patient's mindset, symptoms, and functional limitations. (1) Comparing patients who rated their physicians as perfectly empathic with those who did not, is there a difference in pre- to postvisit change in Patient Reported Outcome Measurement Information System (PROMIS) Upper Extremity Function scores? (2) Do patients who gave their physicians perfectly empathic ratings have a greater decrease in pre- to postvisit change in Pain Intensity, PROMIS Pain Interference, and PROMIS Depression scores? Between September 2015 and February 2016, based on the clinic patient flow, 134 new patients were asked to participate in this study. Eight patients were in a rush to leave the surgeon's office, which left us with a final cohort of 126 patients. Directly before and directly after the appointment with their physician, patients were asked to complete three PROMIS Computerized Adaptive Tests (CAT; Upper Extremity Function, Pain Interference, and Depression) as well as an ordinal rating of pain intensity. After the visit, participants were asked to rate their physician using the Consultation And Relational Empathy (CARE) measure. Based on prior experience, we dichotomized the CARE score anticipating a substantial skew: 54 patients (43%) rated their physician perfectly empathic. Between patients who rated physicians as perfectly empathic and those who did not, there was no difference in the pre- to postvisit change in PROMIS Upper Extremity Function CAT score (perfect empathy: 0.84 ± 2.94; less than perfect empathy: -0.23 ± 3.12; mean difference: 0.23; 95% confidence interval [CI], -0.31 to 0.77; p = 0.054). There was a small decrease in Pain Intensity (perfect empathy: -0.96 ± 2.08; less than perfect empathy: -0.33 ± 1.03; mean difference: -0.60; 95% CI, -0.88 to -0.32; p = 0.028). There were no differences in PROMIS Pain Interference score (perfect empathy: -1.33 ± 2.85; less than perfect empathy: -1.37 ± 3.12; mean difference: -1.35; 95% CI, -1.88 to -0.83; p = 0.959) or PROMIS Depression scores (perfect empathy: -1.51 ± 4.02; less than perfect empathy : -1.21 ± 3.83;