医学中的同理心：整骨疗法医生和对抗疗法医生的人际态度、同理心、沟通方式及其患者的临床状况：一项基于疼痛登记处的研究

Empathy in Medicine Osteopathic and Allopathic Physician Interpersonal Manner, Empathy, and Communication Style and Clinical Status of Their Patients: A Pain Registry-Based Study.

作者信息

Licciardone John C, Schmitt Monika E, Aryal Subhash

出版信息

J Am Osteopath Assoc. 2019 Aug 1;119(8):499-510. doi: 10.7556/jaoa.2019.092.

DOI:10.7556/jaoa.2019.092

PMID:31305871

Abstract

CONTEXT

Comparisons of osteopathic physicians (ie, DOs) and allopathic physicians (ie, MDs) on interpersonal manner, including empathy and communication style, have been limited by such methodologic issues as self-assessment and a focus on medical students rather than practicing physicians.

OBJECTIVE

To compare perceptions of the interpersonal manner, empathy, and communication style of DOs and MDs and corresponding clinical measures reported by their patients.

METHODS

A cross-sectional study of adults with subacute or chronic low back pain was conducted within the PRECISION Pain Research Registry from April 2016 through December 2018. A total of 313 patients having their physician for 1 year or longer reported sociodemographic and clinical characteristics, including use of nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids for low back pain. Using validated research instruments, they also reported perceptions of their physician's interpersonal manner, empathy, and communication style and clinical measures of pain catastrophizing, pain self-efficacy, low back pain intensity, back-related disability, and deficits in quality of life relating to sleep disturbance, pain interference with activities, anxiety, depression, and low energy/fatigue.

RESULTS

Patients treated by DOs were less likely to be using NSAIDs (odds ratio [OR], 0.60; 95% CI, 0.36-0.997) or opioids (OR, 0.57; 95% CI, 0.32-0.998) than patients treated by MDs. Patients treated by DOs reported lesser pain catastrophizing (mean, 12.5; 95% CI, 10.1-15.0 for DOs vs 18.1; 95% CI, 16.3-19.9 for MDs; P<.001) and greater pain self-efficacy (mean, 39.5; 95% CI, 36.3-42.8 for DOs vs 35.3; 95% CI, 33.4-37.3 for MDs; P=.03). Correspondingly, patients treated by DOs reported lesser back-related disability (mean, 11.2; 95% CI, 9.9-12.5 for DOs vs 13.5; 95% CI, 12.8-14.3 for MDs; P=.002) and a trend toward lesser deficits in quality of life. Patients reported more favorable perceptions of DOs on interpersonal manner (mean, 4.3; 95% CI, 4.2-4.5 for DOs vs 4.0; 95% CI, 3.9-4.2 for MDs; P=.01) and empathy (mean, 41.2; 95% CI, 39.1-43.3 for DOs vs 38.0; 95% CI, 36.5-39.5 for MDs; P=.02).

CONCLUSION

The mechanisms underlying lesser use of NSAIDs and opioids, superior clinical status measures, and more favorable perceptions of physician interpersonal manner and empathy reported by patients treated by DOs warrant further investigation.

摘要

背景

整骨疗法医生（即DO）与对抗疗法医生（即MD）在人际态度（包括同理心和沟通方式）方面的比较，受到诸如自我评估以及侧重于医学生而非执业医生等方法学问题的限制。

目的

比较患者对整骨疗法医生和对抗疗法医生人际态度、同理心和沟通方式的看法，以及患者报告的相应临床指标。

方法

2016年4月至2018年12月期间，在精准疼痛研究登记处对患有亚急性或慢性下背痛的成年人进行了一项横断面研究。共有313名有1年或更长时间就诊医生经历的患者报告了社会人口统计学和临床特征，包括使用非甾体抗炎药（NSAIDs）和阿片类药物治疗下背痛的情况。他们还使用经过验证的研究工具，报告了对医生人际态度、同理心和沟通方式的看法，以及疼痛灾难化、疼痛自我效能感、下背痛强度、背部相关残疾以及与睡眠障碍、疼痛对活动的干扰、焦虑、抑郁和低能量/疲劳相关的生活质量缺陷等临床指标。

结果

与接受对抗疗法医生治疗的患者相比，接受整骨疗法医生治疗的患者使用非甾体抗炎药（优势比[OR]，0.60；95%置信区间[CI]，0.36 - 0.997）或阿片类药物（OR，0.57；95% CI，0.32 - 0.998）的可能性较小。接受整骨疗法医生治疗的患者报告的疼痛灾难化程度较低（平均值，整骨疗法医生为12.5；95% CI，10.1 - 15.0，对抗疗法医生为18.1；95% CI，16.3 - 19.9；P <.001），疼痛自我效能感较高（平均值，整骨疗法医生为39.5；95% CI，36.3 - 42.8，对抗疗法医生为35.3；95% CI，33.4 - 37.3；P =.03）。相应地，接受整骨疗法医生治疗的患者报告的背部相关残疾较少（平均值，整骨疗法医生为11.2；95% CI，9.9 - 12.5，对抗疗法医生为13.5；95% CI，12.8 - 14.3；P =.002），并且在生活质量缺陷方面有减少的趋势。患者对整骨疗法医生的人际态度（平均值，整骨疗法医生为4.3；95% CI，4.2 - 4.5，对抗疗法医生为4.0；95% CI，3.9 - 4.2；P =.01）和同理心（平均值，整骨疗法医生为41.2；95% CI，39.1 - 43.3，对抗疗法医生为38.0；95% CI，36.5 - 39.5；P =.02）的看法更积极。