January 29, 2013
Doctors Experience Pain, Relief Based On Patient Treatment Reactions
Brett Smith for redOrbit.com - Your Universe Online
New research from the Massachusetts General Hospital and Beth Israel Deaconess Medical Center at Harvard Medical School has shown that doctor´s actually experience pain and relief based on their patients' reactions to treatment.
The study, which was done by performing brain scans on doctors as they treated patients, provides new insight into the doctor-patient relationship.
"Our findings showed that the same brain regions that have previously been shown to be activated when patients receive placebo therapies are similarly activated in the brains of doctors when they administer what they think are effective treatments," explained lead author Karin Jensen, an investigator in the Department of Psychiatry and Martinos Center for Biological Imaging at MGH.
The study also showed that more empathetic physicians reporting a greater ability to see patients' perspective experienced higher satisfaction during patients' treatments.
Previous research has shown that physicians' expectations can sway patients' clinical outcomes and influence patients' placebo responses. Jensen and her colleagues hypothesized that this was due to a biological response in the physicians´ brain regions that mirrors those of patients during patients' placebo treatments and responses. This led them to believe that a physician's perceptions would influence the outcomes.
To test the hypotheses, the Boston scientists designed a unique experiment that allowed them to image the physicians' brains while the doctors met with patients and proceeded to observe these patients while administering what they believed were pain treatments.
The experiment included 18 physicians and 2 female "patients", who followed a rehearsed script. In the experiment, the physicians were told to meet with the patients and administer pain relief with what was actually a fake device.
To show the doctors that the treatment device “worked”, the researchers used another device to administer a dose of heated pain to the physicians' forearms, allowing the researchers to gauge pain responses. The doctors then "treated" them with the fake machine. To administer “treatment”, the investigators reduced the painful heat stimulus, resulting in the perception that the treatment device worked.
Next, each physician subject was introduced to a patient and asked to perform a standardized clinical examination, which was done to establish a realistic rapport between the physician and the patient. After the standard exam, the physician answered a questionnaire (Interpersonal Reactivity Index) to measure their perspective-taking skills.
Finally, the physician and patient were led into the scanner room, where the patient was hooked up to both the thermal pain stimulator and the pain-relieving device.
"The physician went inside the scanner and was equipped with a remote control that could activate the 'analgesic device' when prompted," she explained.
While able to establish eye-contact with their patients, the physicians were randomly told to either treat a patient's pain or to press a control button that provided no relief.
When physicians did not activate pain relief, the "patient" gave a painful facial expression while the subjects looked on. When the physicians administered treatment, they could see their patients´ positive reactions to pain relief. During the entire time, fMRI scans measured the doctors' brain responses.
Following the scanning session, the physicians were told the true nature of the experiment.
"If the physician did not agree with the deceptive component of the study, they were given the opportunity to withdraw their data. No one did this,” Jensen said.
The results of the study confirm the researchers´ initial suspicions–physicians´ brains responded to the perception of treatment even though none was actually given.
"We already know that the physician-patient relationship provides solace and can even relieve many symptoms," said senior author Ted Kaptchuk, an associate professor at Harvard Medical School. "Now, for the first time, we've shown that caring for patients encompasses a unique neurobiology in physicians.”
“Our ultimate goal is to transform the 'art of medicine' into the 'science of care,' and this research is an important first step in this process as we continue investigations to find out how patient-clinician interactions can lead to measurable clinical outcomes in patients,” he added.