II-15 Improving Communication and Using Placebos

Question 1

Identify the one reliable predictor of physician sensitivity.

Answer 1

Efforts to identify the personalities of physicians who communicate effectively have revealed only one reliable predictor of physical sensitivity: the physician’s reported interest in people.

Question 2

Describe the characteristics and benefits of patient-centered communication.

Answer 2

This type of communication involves the patient directly in decisions about medical care. It also focuses on: respect, empathy (putting oneself in the patient’s position); greeting patients; addressing them by name; and explaining the purpose of any procedure.
The benefits are that it improves interactions with patients—especially those that have been labeled as “difficult” because they take an active interest in their treatment.

Question 3

Discuss the qualities that a good communication course should have.

Answer 3

1. Giving students direct, supervised contact with patients.
2. Imediate feedback after a patient interview.
3. Videotaping interactions with patients.

Question 4

Name two institutional interventions that can foster adherence.

Answer 4

1. Postcard reminders or telephone calls to patients reminding them to return can reduce high rates of no-shows.
2. Reducing the amount of time a patient must wait before receiving service also improves the rate of following through on appointments.

Question 5

Identify ways of presenting the treatment regimen that improve adherence.

Answer 5

• Giving the patient a medication information sheet that describes the treatment, the dosage level of medication, and possible side effects can also improve compliance.
• Take-home pill calendars, special pill packaging designed to aid recall, and pill containers with time-alarm buzzers are also helpful devices.

Question 6

Give an example of the role of placebo effects in active treatment:

Answer 6

In one study, patients complaining of pain were injected with either morphine or a placebo. Although morphine was substantially more effective in reducing pain that was the placebo, the placebo was a successful painkiller in 35% of the cases.

Question 7

Describe the qualities of the provider, the patient and the setting that are most conducive to placebo effects.

Answer 7

• Provider characteristics: Providers who exude warmth, confidence, and empathy get stronger placebo effects than do more remote and formal providers. Placebo effects are also strengthened when the provider radiates competence and provides reassurance to the patient that the condition will improve. The provider’s faith in the treatment increases the effectiveness of placebos.
• Patient characteristics: People who have a high need for approval or low self-esteem, who are externally oriented toward their environment, and who can be persuaded easily in other contexts show stronger placebo effects. Anxious people experience stronger placebo effects. So do patients who are high in hypnotizability, imaginative involvement, and effortless experiencing.
• Setting characteristics: A setting that has the trappings of medical formality (medications, machines, uniformed personnel) will induce stronger placebo effects than will a less formal setting. If all the staff radiates as much faith in the treatment as the physician, placebo effects will be heightened.

Question 8

Discuss the prevalence of medication use among hospitalized and non-hospitalized patients.

Answer 8

Hospitalized patients receive, on average, 14 drugs at the same time. 55% of non-hospitalized adults have taken at least one medication in the past day, and 40% use some medication on a regular basis. Over 750,000 people a year report adverse side effects from a medication they are taking.

Question 9

placebo

Answer 9

a medical treatment that produces an effect in a patient because of its therapeutic intent and not its nature.

Question 10

placebo effect

Answer 10

The medically beneficial impact of an inert treatment.

Question 11

double-blind experiment

Answer 11

An experimental procedure in which neither the researcher nor the patient knows whether the patient received the real treatment or the placebo until pre-coded records indicating which patient received which are consulted; designed to reduce the possibility that expectations for success will increase evidence for success.