Published January 31, 2013
For women about to embark on nine months of pregnancy or for cancer patients undergoing their first round chemotherapy, finding the perfect doctor is always crucial.
Having the right physician who makes a patient feel comfortable and safe can influence everything from patient satisfaction to even clinical outcomes.
While many studies have focused on how the patient benefits from the doctor-patient relationship, very few have focused on how the physician feels when he or she treats someone. As it turns out, the doctor is more in-tune with the patient experience than one might think.
Researchers from Massachusetts General Hospital (MGH) and Beth Israel Deaconess Medical Center/Harvard Medical School conducted a novel investigation into the minds of doctors, performing brain scans on physicians while they believed they were treating patients.
Walking a mile in patients’ shoes
Analysis of the scans revealed that doctors put themselves in their patients’ shoes – as their brains actually feel the pain their patients feel.
“Everyone studies the biology of the placebo effect in the patient,” lead author Ted Kaptchuk, director of the Program in Placebo Studies and Therapeutic Encounter (PiPS) at Beth Israel and associate professor of medicine at Harvard Medical School, told FoxNews.com. “We said, ‘Why don’t we change the camera, and turn it around and look at what happens inside the brains of physicians while they’re treating patients?’ … We know that physicians influence patients, so we wanted to know something about the biology that underlies that influence.”
Past research has found that certain areas of the brain are activated when a person experiences the placebo effect – when patients show improved health after being given medicine without any active ingredients. During this response, when a patient experiences pain relief, his or her right ventrolateral prefrontal cortex (VLPFC) is activated, and when he or she experiences reward, the rostral anterior cingulate cortex (rACC) activates.
Through an extensive social and medical experiment, Kaptchuk and his colleagues tested this effect on group of 18 physicians from different medical specialties who had all received their degrees within the past decade. They developed a unique scenario in which the physicians would undergo functional magnetic resonance imaging (fMRI) on their brains as they interacted and observed patients.
The first phase of the experiment involved conducting neuro-imaging of the physicians’ brains as they experienced pain first hand. The researchers introduced them to a pain-relieving electronic device, which was actually a “sham” machine, which simply administered “heat pain.” To make the researchers believe the device truly worked, they used the machine to administer the heat pain and then “treated” them with the machine to simulate pain relief; in reality they simply reduced the heat stimulation.
Once the doctor’s fMRI scans were finished, each physician was introduced to a patient and was asked to conduct a standardized clinical examination. This essentially mimicked a standard doctor’s appointment and help the individuals to establish a relationship – albeit small.
Finally, each doctor-patient pair was asked to enter a scanner room, where the patient was hooked up to the sham pain-relieving device from the earlier stage of the experiment. While hooked up to an fMRI, the doctors were given remote controls, which could either administer pain to their patient or relieve them of it. In reality, the patients – who were actually confederates of the research team – would grimace in order to pretend he or she was experiencing discomfort and then relax to simulate relief.
Through the use of mirrors, the physicians were able to see their patients’ faces as they believed the device administered pain or relieved it.
“During this, we looked at what was going on in the physician’s brain,” Kaptchuk said. “We saw that when the patient was in pain, the physician’s brain activated the regions that we had earlier imaged in the physician of their pain networks. Meaning when the patient was in pain, the physician felt pain. They shared the pain.”
As the researchers noted in the first phase of the experiment, the physicians activated the right VLPFC region when they believed they were treating their patients.
According to Kaptchuk, this is the first experiment of its kind to show a physical underpinning to the doctor-patient relationship. He hopes this will eventually provide the medical community with clues as to how they can better match doctors and patients.
“It highlights that what was once in intangible in terms of discussing health care – well we can actually see a biology to it,” Kapthcuk said. “We think that’s a way of putting increased value in it. We like the molecules, we like the actually physiology of things besides just how patients feel and doctors feel. And this is a way of saying there is a biology and we need to pay more attention… to the doctor-patient relationship.”
The study was published online in Molecular Psychiatry.