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In the era of personalized diabetes medicine, AI and genomics, it is nice to win a victory for human contact in the old days. A British study found that the perceived empathy of general practitioners and nurses can reduce the risk of premature death of some of their patients with diabetes.
Diabetes care currently accounts for about 10% of the NHS budget, but it is problematic for patients to take prescribed medications and understand the importance of lifestyle changes.
Reduce mortality: it's good to talk
Researchers from Cambridge University sent follow-up questionnaires to 867 people participating in the Anglo-Danish-Dutch study on intensive treatment in people with diabetes detected at screening (ADDITION) – Cambridge, taken from 49 England .
They wanted to determine whether there was a correlation between the empathy felt at GP appointments and the risk of cardiovascular disease or death of patients.
Responses to the help of the consultation and relationship empathy questionnaire (CARE) were received from 628 participants. Among these:
Those who reported better empathic experiences with health practitioners in the first 12 months after diagnosis had a 40-50% lower mortality risk over the next 10 years than those with low empathy. generalists.
Although not statistically significant, those reporting empathy also tended to be at lower risk for cardiovascular events.
The results were published online on July 8th.th in Annals of Family Medicine.
The study benefited from the actual CVM data and from a relatively large population. However, CARE empathy scores were self-reported and the authors acknowledged the limitations of the participants' ethnic diversity.
"We must take the time"
The authors expected empathy to make a difference, but they were always surprised by the results.
"As a doctor, I think that empathy is extremely important, and that's part of what we learn and what we practice, but I did not expect such a significant result. 40% lower mortality risk is more important than any drug on Dr. Hajira Dambha-Miller, general practitioner and researcher at the Department of Public Health and Primary Health Care, University, felt that some effects would be larger than expected. of Cambridge, stated 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 their duration to be increased to 15 minutes for most patients and even more for those with more complex needs.
"We need to spare some time," says Dr. Dambha-Miller. Despite "the stress that we have in general, our services are overwhelmed, we do not have enough manpower, we do not have enough money and resources, our population increases.
"But even if it 's only one minute listening to our patients and developing our management plans with them, the impact on the long-term results are so important that we have to find the time, even if it means that our system has to be rethought, and the government needs to rethink the resources needed to help us provide the type of empathic drug. "
Commissioners may consider spending more time talking to high-cost patients. "Nothing proves that empathy costs more," she says. "Looking at the literature, definitely in my own practice, I do not think it costs more, because in reality, if we really have to listen to our patients and develop plans with them, the evidence that I've produced, and more widely in the literature, suggests to our patients to adhere to drugs.
"In type 2 diabetes, we spend about 10 billion pounds in the NHS, about 30% of people do not take their medications.If a doctor really listens and hears what the patient has to say, and really takes in account Their concerns, the evidence we have produced suggest that they will go out and adhere to these medications, or adhere to behavior change, such as physical activity, or diet changes I think that in the long run, it could cost a lot more -effective. "
Reality
So, what does empathy look like in real life? We asked Dr. Dambha Miller for an example from her own practice. "Friday, I saw a patient with type 2 diabetes. And it is a patient who has not attended a lot of appointments, which presents a high risk of d." Cardiovascular events I think the problem is that he has seen a lot of different people over the years.
"Sitting with him, even just for a 10-minute consultation, rather than following the protocol imposed on us by the NHS, we have to choose our different tasks as general practitioners, we are paid according to the biological targets We have to to get together, but by ignoring all that and just asking ourselves to look, what should we do, how can we fit in and what can we do differently?
"Taking this time, I think, started a relationship that makes me very optimistic because I'm pretty sure that it's called to make another appointment with me." That made a huge difference just for to get the patient out the door and for him to really engage This is the first step, which stems from the empathic consultation that has not taken more than 10 minutes.
"Obviously, I have no evidence as to what will happen clinically in the long run, but my research certainly suggests that in the next 10 years, it will make a huge difference in terms of mortality. "
The research received funding from the National Institute of Health Research (NIHR), the Council of Medical Research and Wellcome. The authors do not report any conflict of interest.
Dambha-Miller, H et al. Association between the empathy of the primary health care practitioner, the risk of cardiovascular events and all-cause mortality in patients with type 2 diabetes: a population-based prospective cohort study. Annals of Family Medicine; July 8, 2019.
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