Improved health outcomes in integrative medicine visits may reflect differences in physician and patient behaviors compared to standard medical visits |
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| Authors: | Michelle L. Dossett Judith A. Hall Ted J. Kaptchuk Gloria Y. Yeh |
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| Affiliation: | 1. Division of General Internal Medicine, Geriatrics, and Bioethics, University of California, Davis, Sacramento, USA;2. Division of General Internal Medicine and Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Boston, USA;3. Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, USA;4. Department of Psychology, Northeastern University, Boston, USA;1. New York University Grossman School of Medicine, Department of Population Health, New York, NY 10016, United States;2. Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO 80045, United States;3. Cancer Prevention and Control Program, University of Colorado Cancer Center, Aurora, CO 80045, United States;4. Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa FL 33612, United States;1. Cancer Experiences Research, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, Victoria, 3000, Australia;2. Day Therapies & Radiotherapy, Peter MacCallum Cancer Centre, Melbourne, Australia;3. Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia, Melanoma and Skin Service, Peter MacCallum Cancer Centre, Melbourne, Australia;4. Lung Service, Peter MacCallum Cancer Centre, Melbourne, Australia;5. Lifebuoy, Melbourne, Australia;1. Gold Coast Hospital and Health Service, Gold Coast, Australia;2. Griffith University School of Medicine, Gold Coast, Australia;3. Compassionate Gold Coast, Australia;4. Charter for Compassion, Australian Compassion Council, Australia;5. Deakin University Faculty of Health, School of Medicine, Australia;6. HammondCare, Greenwich Hospital, Sydney, Australia;7. Northern Clinical School University of Sydney, Sydney, Australia;8. Bond University, School of Health Science and Medicine, Australia;1. Health, Medical and Neuropsychology Unit, Leiden University, Leiden, Netherlands;2. Leiden Institute for Brain and Cognition (LIBC), Leiden, Netherlands;3. Oncology Center, Leiden University Medical Center, Leiden, Netherlands;4. Department of Psychiatry, Leiden University Medical Center, Leiden, Netherlands;1. EPIUnit-Public Health Institute, Porto University, Porto, Portugal;2. Departament of Public Health Sciences, Medicine Faculty, Porto University, Porto, Portugal;3. National Health Council, Lisbon, Portugal |
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| Abstract: | ObjectiveTo identify differences in patient-physician interactions associated with improvements in GERD symptoms in a randomized controlled trial comparing integrative medicine and primary care/standard visits.MethodsWe analyzed video recordings of 2-minute excerpts (thin slices) from the beginning, middle, and end of 21 study visits (11 standard, 10 integrative medicine).ResultsAccording to blind coders’ analysis of the excerpts, prospective improvement in GERD symptoms was most highly correlated with patients appearing pleased (r = 0.71, p < 0.01) and friendly (r = 0.67, p < 0.01) at the end of the visit, controlling for visit type. The combination of patient and physician smiling at the end of the visit was associated with improvement in GERD symptoms (r2 = 0.45, p = 0.004). The physician in the integrative visits was more engaged (p = 0.009), friendly (p = 0.005), relaxed (p = 0.002), smiled longer (p = 0.006), gazed longer (p = 0.02), and gestured more (p = 0.007), compared to standard visits. Patients in integrative visits also smiled longer (p = 0.004).ConclusionThe expanded history-taking questions asked by integrative clinicians may enhance relationship building, modifying patients’ responses and improving patient-centered behaviors from clinicians,ultimately facilitating symptom improvement.Practice ImplicationsAnalysis of nonverbal behaviors may facilitate a better understanding of patient-clinician interactions in integrative medicine visits and yield insights to improve clinical interactions in conventional medicine. |
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| Keywords: | Physician-patient relations Gastroesophageal reflux Integrative medicine Patient-Centered care Nonverbal communication Video recording |
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