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For Robert Rountree, MD, a family practitioner in Boulder, CO, shifting from the traditional disease- centered to the patient-centered approach to healing produces inestimable benefits and can have a profound impact on the final outcome.
Rountree cites a series of studies in which patients are asked what they recall most about medical examinations. Many times, the most prominent memory is whether or not the physician touched them. "We may think one thing as providers, but patients are experiencing something completely different," he says. "Their illness is part of a long story, and their encounter with a doctor is only one step in that journey. Often, as far as the doctor is concerned, the only thing that’s important is whether or not they’re following the right protocol."
The doctor-patient relationship is the most important aspect of medical care, Rountree asserts. Yet the nature of managed care discourages health care providers from spending any significant amount of time with their patients. "The message being put out is that it really doesn’t matter who you see, as long as they go by the book. The placebo effect has been shown to account for 40% or more of the effect of any medication, but it’s pretty hard to take advantage of that effect if we’re implying that doctors are just little robots that can be plugged in and out."
Rountree is not alone in his opinions. For example, Stanley Joe Reiser, MD, MPA, PhD, wrote in JAMA: "The health care that consumers receive should reflect their individuality. This lesson should be given to students in teaching and research settings: that understanding human diversity must be a central goal in acquiring and using medical knowledge. Effort in this area will further the development of a more person-centered and human health care system."1
Few primary care physicians would disagree with the proposition that the doctor-patient relationship plays a key role in healing, adds Rountree. But they might argue with the strength of the research data to support the idea. "We don’t understand enough about the mind-body connection to take full advantage of it," he says. "We simply know there’s an effect."
Despite the difficulties in quantifying the value of factors such as the doctor-patient relationship or the power of nontraditional therapies, some researchers have made serious attempts to do just that. In one such endeavor, investigators conducted a series of five experiments to examine the effect of various complementary healing interventions on the re-epithelialization of wounds.2 The interventions included experimental derivatives of a technique known as Therapeutic Touch. A total of 146 subjects participated in the study. In two of the five experiments, the results were statistically significant, but the investigators concluded that the overall results were inconclusive in establishing the efficacy of the selected interventions.
"Since the series of experiments did not demonstrate a consistent reproducible treatment effect, additional research is required in order to further examine the central hypothesis that complementary healing intervention has the potential to accelerate the reepithelialization rate of full-thickness human dermal wounds," writes Daniel P. Wirth, MS, one of the study’s authors.
Hard data to prove that interventions such as touch improve healing are hard to come by. Still, Rountree and others strongly emphasize the need for health care professionals to pay more attention to this softer side of medicine, even if that just means spending more time getting to know patients, helping to allay their fears, and treating them holistically.
"It seems odd that we’d have to tell people that, but we’ve gotten away from treating patients as normal humans," he says. "If we can do nothing more than try to see a patient as a real person, not just a walking wound or a disease that happens to be attached to that person, then we can make a huge impact."
1. Reiser SJ. Using the experience of illness in shaping the missions of health care. JAMA 1993; 269:1,012-1,017.
2. Wirth DP, Richardson JT, Eidelman WS. Wound healing and complementary therapies: A review. J Altern Comp Therapies 1996; 2:493-502.