Family Medicine Residency, Northern Light Eastern Maine Medical Center, Orono, ME, USA.
Department of Family Medicine, University of New England College of Osteopathic Medicine, Biddeford and Bangor, ME, USA.
J Altern Complement Med. 2021 Aug;27(8):688-696. doi: 10.1089/acm.2020.0449. Epub 2021 Jun 29.
Within family medicine it is generally accepted that the more we know about patients' lives, the better the care we provide. Few studies have sought to quantify this historical assumption. We wondered if knowing their chronic pain, patients' life stories would improve the physician-patient relationship in a family medicine residency training program clinic. We selected patients in chronic pain with depression and/or anxiety who were considered difficult. After a lead in period to establish stability of ratings, we obtained a life story interview for 125 such patients after administering the doctor-patient relationship questionnaire to them and their physicians. Patients completed the McGill Pain Inventory (MPQ), the Zung Anxiety Inventory, and the Center for Epidemiological Studies Depression Scale. Physicians completed the Jefferson Physicians Empathy Scale. Questionnaires were repeated every 4 months. The quality of the physician-patient relationship increased significantly over the course of the year for patients (increase of 0.60, standard deviation [SD] = 0.13, 95% confidence interval [CI] = 0.57 to 0.63, < 0.001) and for doctors (increase of 0.77, SD = 0.20, 95% CI = 0.72 to 0.81, < 0.001). The perceived level of pain on the MPQ decreased significantly on the sensory component (71.2 ± 7.6 to 11.7 + 9.4, 95% CI = 0.589 to 9.411, = 0.0270 and the affective component (4.2 + 3.4 to 2.1 + 4.3, 95% CI = 0.131 to 4.069, = 0.037). Anxiety and depression ratings did not change. Physicians' empathy ratings increased significantly over the course of the year from a mean of 117.2 (SD = 10.2) to 125.1 (SD = 16.1) for a difference of 7.90, which was significant at = 0.0273 with a 95% CI of -14.85 to -0.915. Knowing the patient's life story improves the physician-patient relationship for both patients and physicians. When the physician-patient relationship improves, the perceived level of pain decreases. Physicians' empathy ratings increase. While the interview requires 90-120 min, it is billable, and can be done by medical students, medical assistants, social workers, or behavioral health. Obtaining life stories of chronic pain patients is a cost-effective way to reduce pain while simultaneously improving the physician-patient relationship and increasing physician empathy.
在家庭医学中，人们普遍认为我们对患者生活了解得越多，提供的护理就越好。很少有研究试图量化这一历史假设。我们想知道，了解他们的慢性疼痛是否会改善家庭医学住院医师培训诊所中医生与患者的关系。我们选择了患有抑郁症和/或焦虑症的慢性疼痛患者，这些患者被认为是比较困难的。在建立稳定的评分期之后，我们对 125 名此类患者进行了生活故事访谈，在此之前，我们向他们和他们的医生发放了医生与患者关系问卷。患者完成了麦吉尔疼痛问卷（MPQ）、Zung 焦虑量表和流行病学研究中心抑郁量表。医生完成了杰斐逊医生同理心量表。每隔 4 个月重复一次问卷。在这一年中，患者的医患关系质量显著提高（提高 0.60，标准差[SD] = 0.13，95%置信区间[CI] = 0.57 至 0.63， < 0.001），医生的医患关系质量也显著提高（提高 0.77，SD = 0.20，95% CI = 0.72 至 0.81， < 0.001）。MPQ 感觉分量表上的感知疼痛程度显著降低（71.2 ± 7.6 至 11.7 + 9.4，95% CI = 0.589 至 9.411， = 0.0270），情感分量表上的感知疼痛程度也显著降低（4.2 + 3.4 至 2.1 + 4.3，95% CI = 0.131 至 4.069， = 0.037）。焦虑和抑郁评分没有变化。医生的同理心评分在这一年中显著提高，从平均 117.2（SD = 10.2）提高到 125.1（SD = 16.1），差值为 7.90，这在统计学上具有显著意义， = 0.0273，95% CI 为 -14.85 至 -0.915。了解患者的生活故事可以改善患者和医生的医患关系。当医患关系改善时，患者的感知疼痛程度会降低。医生的同理心评分会增加。虽然访谈需要 90-120 分钟，但它是可以计费的，可以由医学生、医疗助理、社会工作者或行为健康专家来进行。了解慢性疼痛患者的生活故事是一种既可以减轻疼痛，同时又能改善医患关系并增加医生同理心的具有成本效益的方法。
