The Softer Side of Better Patient Outcomes
It goes almost without saying that a patient’s return to work after an orthopaedic injury or musculoskeletal disorder would correlate with the severity of the condition. But what about the connection between return to work and a more “touchy-feely” parameter, such as the patient-surgeon relationship?
Dubert et al. conducted a longitudinal observational study of 219 patient who were 18 to 65 years of age and had undergone operations for upper-limb injuries or musculoskeletal disorders. In the August 7, 2019 issue of JBJS, they report that a positive relationship between patient and surgeon hastened return to work and reduced total time off from work.
At the time of enrollment (a mean of 149 days after surgery), the authors assessed the patient-surgeon relationship with a validated, 11-item questionnaire called Q-PASREL, and they collected patients’ functional and quality-of-life scores at the same time. The authors then tracked which patients had returned to work 6 months later, and they calculated how many workdays those who did return had missed.
The Q-PASREL questionnaire explores surgeon support provided to the patient, the patience of the surgeon, the surgeon’s appraisal of when the patient can return to work, the cooperation of the surgeon regarding administrative issues, the empathy perceived by the patient, and the surgeon’s use of appropriate vocabulary.
Here is a summary of the findings:
- At 6 months after enrollment, 74% of patients who had returned to work had given their surgeon a high or medium-high Q-PASREL score. By contrast, 64% of the patients who had not returned to work had given their surgeon a low or medium-low Q-PASREL score.
- The odds of returning to work were 56% higher among patients who gave surgeons the highest Q-PASREL scores compared with those who gave surgeons the lowest scores.
- The “body structure” subscore on one of the functional measurements and the Q-PASREL quartile were the only two independent predictors of total time off from work among patients who had returned to work.
After asserting that their study “confirms that surgeons’ relationships with their patients can influence the patients’ satisfaction and outcomes,” Dubert et al. go on to suggest that the findings should prompt surgeons to “work on empathy, time spent with their patients, and communication.” While they rightly claim that such improvements would entail “little financial investment and no side effects,” perhaps the authors, who practice in France, underestimate the effort that goes into changing behavior—and into addressing the time constraints imposed by the US health care system?
Empathic Orthopaedists: Worth Waiting For
When I was a waiter during high school and college, I quickly learned the value of connecting with my customers. If I could fulfill whatever role they were looking me to fill (i.e., being fun and interactive, serious, acting invisible, or anything in between), I would usually be rewarded with a sizable tip or a compliment. I realized that I was not there primarily to help customers make food choices, but rather to make each customer feel as though I existed only to care for them. There is a big difference between those two roles, and I found myself thinking about those experiences while reading the article by Kortlever et al. in the February 20, 2019 issue of JBJS.
The authors aimed to determine whether an association existed between a patient’s wait time and the amount of time he or she spent with a surgeon and the patient’s perception of the surgeon’s empathy. Considering the well-established connection between the perceived empathy coming from a physician and patient satisfaction, this is an important question to examine. Interestingly, Kortlever et al. found that neither time-related variable was associated with perceived physician empathy, suggesting that decreasing wait times or spending more time with individual patients may not increase their satisfaction with the visit. However, the authors did find a direct, inverse association between surgeon stress levels and patient-perceived empathy. Specifically, for every 1-point increase in a surgeon’s self-reported stress (as measured with the Perceived Stress Scale short form), there was a 0.87 decrease in perceived empathy (as measured with the Jefferson Scale of Patient’s Perceptions of Physician Empathy).
Like most humans, patients value the quality of an interaction more than its duration. Similarly, patients are more concerned with what happens during their medical appointment than with the wait time that transpires before it. It probably does not take very long for a patient to feel that you are fully engaged with his or her concerns—or not—and increasing the length of a “bad” interaction usually will not increase its quality. Patients may not always know whether your medical advice is on target, but almost all of them can tell how much you care and whether you are “present” during their appointment.
I agree with the authors’ conclusion that the present findings indicate “that the patient-physician relationship is more built on actions and communications than on time spent.” I suspect that future studies will continue to show how powerful the perceptions of caring and empathy are when it comes to patient care.
Chad A. Krueger, MD
JBJS Deputy Editor for Social Media
Editor’s Note: Kortlever et al. cite a 2005 Instructional Course Lecture by Tongue et al. that describes easy-to-learn skills for effective and empathic patient-centered interviews. Click here for full text of that article.
Try Clinical Classroom
Recent Comments