Does the quality of the relationship between patient and doctor/healthcare practitioner really make a difference? We all want to feel listened to and have time with a doctor, but is there evidence that this connection actually impacts our health?

An interesting study published in Canada in 2014 looked at the effect of the “therapeutic alliance” between patient and provider on chronic back pain. Back pain is the third most common non-acute reason that people go to see their doctor.

Study groups

The study design included 117 patients with chronic low back pain who were randomized to one of four groups. The groups received the following treatments: 

Group 1. Sham interferential current therapy (IFC), where IFC equipment was placed on the lower back, but no current was applied. 

Group 2. Active IFC, where a mild electric stimulation current was applied to the lower back.

Group 3. Sham IFC plus enhanced therapeutic alliance.

Group 4. Active IFC plus enhanced therapeutic alliance.

The patients’ pain, assessment of disability and expectations were measured before and after treatment.  

Positive connection

“Enhanced therapeutic alliance” in this study was described as follows:

During the first 10 minutes of the session, each patient was questioned about their symptoms and lifestyle and the cause of their condition. Practitioners used active listening, non-verbal behaviors, empathy, and offered words of encouragement about getting better. The aim was to create an optimal patient-clinical relationship. The therapist remained in the room during the treatment, and verbal interaction was encouraged.

For those groups without enhanced therapeutic alliance (groups 1 and 2), the therapist merely introduced herself and explained the purpose of the treatment. The therapist left the room during treatment, with no further conversation with the participant. 

Results

Group 1. Sham IFC alone resulted in 25% decrease in pain. This illustrates a powerful placebo effect, since the equipment was in place but not activated; therefore no treatment was given. This result is interesting in and of itself.  

Group 2. The patients who received IFC did better than the sham group, experiencing a 46% decrease in pain. This illustrates that the IFC treatment does work.  

Group 3. Patients who underwent sham treatment but had therapists who actively communicated with them reported a 55% decrease in their pain. This result should make all health professionals pause: A positive connection with the patient was more effective than treatment alone!

Group 4. The patients who had electrical stimulation and a connection with the therapist were the clear winners with a 77% reduction in pain.

Conclusion

This study provides evidence that a substantial portion of healing comes from the connection between patient and practitioner. This fact has been recognized by healthcare practitioners for years, yet our healthcare system often means that it has to take a back seat. 

Healthcare situation

Time is frequently the main reason behind this. The medical system is built on short appointments providing insufficient time to talk about the patient’s issue, never mind time to build a relationship with the person. It is a system fault, not necessarily the doctor’s fault. Insurance companies and decision makers in the government fail to recognize the power of the patient-provider conversation. Yet it is our most valuable diagnostic tool and, as this study shows, an effective treatment too. 

Some dismiss the connection as a “placebo” effect as if that makes it less valuable. But whatever you call it, that positive connection doesn’t cause harm and can relieve suffering, so is worth serious consideration. 

If you are struggling with your health provider and not getting the care you want, consider making a change. Look for a practitioner/practice who will listen to you and give you some time. Ask how long your first appointment will be. That will provide you with a good indication of the importance they place or can place on making a connection with you.  Or find someone else who will give you that important listening time.  Sometimes it doesn’t have to be a healthcare practitioner – just knowing that one person has actually listened to you can make a significant difference. 

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