GPs Reducing Diabetes Mortality with Empathy
In an age of personalised diabetes medicine, AI, and genomics, it's nice to chalk up a win for the old-fashioned human touch. A UK study has found the perceived empathy of GPs and nurses can reduce the risk of early death for some of their diabetes patients.
Diabetes care currently takes up around 10% of the NHS budget, but there are issues with patients taking the medication they are prescribed and understanding the importance of lifestyle changes.
Reducing Mortality: It's Good to Talk
University of Cambridge researchers issued follow-up questionnaires to 867 individuals who were part of the Anglo-Danish-Dutch Study of Intensive Treatment In People with Screen Detected Diabetes in Primary Care (ADDITION)-Cambridge, drawn from 49 general practices in the East of England.
They wanted to assess whether there was a correlation between empathy experienced in general practice appointments and patients' risk of cardiovascular disease events or death.
Responses using the consultation and relational empathy (CARE) questionnaire were received from 628 participants. Of these:
- 19% experienced a cardiovascular disease event during the subsequent 10 years
- 21% died during follow-up from causes including cancer and heart attack
Those who reported better empathic experiences with healthcare practitioners in the first 12 months after diagnosis had a 40-50% lower mortality risk over the following 10 years compared with those who experienced low GP empathy.
Although not statistically significant, those reporting empathy also tended to have a lower risk of cardiovascular disease events.
The findings were published online on July 8th in Annals of Family Medicine.
The study benefited from actual CVD data and a relatively large population. However, empathy CARE scores were self-reported and the authors acknowledge limitations in the participants' ethnic diversity.
'We Have to Make Time'
The authors were expecting empathy to make a difference but were still surprised by the findings.
"As a doctor, I think empathy is incredibly important. And it's part of what we learn and what we practise. But I wasn't expecting such a significant finding. A 40% lower risk of mortality is more profound than any drug on the market, or any drug in combination on the market. We hypothesised some effects but the level of the effect was much more than I anticipated," Dr Hajira Dambha-Miller, a GP and researcher at the Department of Public Health and Primary Care, University of Cambridge, told Medscape News UK.
The limitations of the standard 10 minute appointment in general practice are well-documented. The Royal College of General Practitioners (RCGP) is campaigning for them to be increased to 15 minutes for most patients, and even longer for those with more complex needs.
"We have to make time for it," Dr Dambha-Miller says, despite "the stress that we have in general practice, our services are overwhelmed, we don't have enough of a workforce, we don't have enough money and resources, our population is growing.
"But even if it's just a minute of really listening to our patients, and really developing our management plans with them, the impact on long-term outcomes is so significant, that we have to find the time, even if it means our system has to be redesigned, and the Government has to rethink about what resources are needed to help us deliver the kind of medicine that is empathic."
Commissioners may equate spending more time talking with patients with higher costs. "There isn't any evidence that empathy costs more," she says. "Looking at the literature, definitely in my own practice, I don't think it costs any more, because actually, if we are to really listen to our patients and develop plans with them, the evidence I've produced, and indeed more widely in the literature, suggests our patients will adhere to medications.
"In type 2 diabetes, we spend about £10 billion in the NHS, of that about 30% of people don't take their medication. If a doctor really listens, and hears what the patient has to say, and really takes on board their concerns, the evidence we've produced suggests they will go away and adhere to those medications, or adhere to the behaviour change, like physical activity, or dietary changes. So in the long-run, I think it could be much more cost-effective."
So what does empathy look like in real life? We asked Dr Dambha-Miller for an example from her own practice. "On Friday, I saw a patient with type 2 diabetes. And this is a patient who's not attended many appointments, who does have a high risk of cardiovascular events. I think the trouble is, he's seen lots and lots of different people over the years.
"Sitting down with him, even just for a 10 minute consultation, rather than going through the protocol that's required of us in the NHS, we have our various things we have to pick off as GPs, we get paid according to the biological targets that we need to meet. But really ignoring all of that, and just saying, look, what do we need to do? How do we get you in? And what can we do differently?
"Taking that time, I think, started a relationship that I feel very positive about because I'm pretty sure he's called up to make another appointment with me. That's made a huge difference just to get the patient through the door and really engage in the process. That's the first step, and that was borne out of the empathic consultation that took not more than 10 minutes.
"Obviously, I don't have the evidence in terms of what will happen long-term clinically, but certainly from my research, it suggests that over the next 10 years, that's going to make a huge difference in terms of his mortality."
Dambha-Miller, H et al. Association between primary care practitioner empathy, and risk of cardiovascular events and all-cause mortality amongst patients with type 2 diabetes: a population based prospective cohort study. Annals of Family Medicine; 8th July 2019.
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