Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Department of Psychiatry and Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Transl Psychiatry. 2020 Jan 21;10(1):17. doi: 10.1038/s41398-020-0712-2.
The goal of this study was to determine the neural correlates of successful doctor-patient interactions. We performed an experimental neuroimaging study where medical doctors (MDs) performed a treatment task while their brain activation pattern was measured, using functional magnetic resonance imaging (fMRI). MDs (25-37 years old) first performed a standardized clinical exam of a "professional patient". Unbeknownst to the doctors, the professional patient was a confederate that rated the doctors' clinical examination using the Consultation And Relational Empathy (CARE) questionnaire, a standardized protocol assessing a clinician's social interaction during a consultation. After the clinical exam, MDs were placed inside a brain scanner and the patient was placed on a chair next to the MD. MDs performed a treatment task where an analgesic device was used to alleviate the patient's pain (experimentally induced), while the MD's brain activity was measured with fMRI. MDs rated their own empathic concern (equivalent of compassion) and personal distress using the Interpersonal Reactivity Index questionnaire. The patient's rating of CARE was robustly related to the MD's own ratings of trait empathic concern and to compassion-related and reward-related activation of medial frontal brain regions during treatment. In contrast, there was no relation with MD's personal distress, nor with activation in regions associated with the aversive component of experiencing empathy. We conclude that a patient's positive experience of a medical examination is reflected in doctors' empathic concern and reward-related brain activations during treatment, suggesting that compassion and pleasure are key factors for successful doctor-patient interactions.
本研究旨在确定成功医患互动的神经相关性。我们进行了一项实验性神经影像学研究，其中医生（MD）在进行治疗任务时测量其大脑激活模式，使用功能磁共振成像（fMRI）。MD（25-37 岁）首先对“专业患者”进行标准化临床检查。医生并不知道，专业患者是一个共谋者，他使用咨询和关系同理心（CARE）问卷对医生的临床检查进行评分，这是一个评估临床医生在咨询期间社交互动的标准化协议。临床检查后，医生被置于大脑扫描仪内，患者被置于医生旁边的椅子上。医生进行治疗任务，使用镇痛装置减轻患者的疼痛（实验诱导），同时使用 fMRI 测量医生的大脑活动。医生使用人际反应指数问卷对自己的同理心关注（相当于同情心）和个人困扰进行评分。患者对 CARE 的评分与 MD 自身特质同理心关注以及与治疗期间中前额叶内侧与同理心相关和奖励相关的激活显著相关。相比之下，与 MD 的个人困扰或与体验同理心的厌恶成分相关的区域的激活没有关系。我们得出结论，患者对医疗检查的积极体验反映在医生在治疗期间的同理心关注和奖励相关的大脑激活中，这表明同情心和愉悦感是成功医患互动的关键因素。
