Empathy as Part of Integrative Health Dr. Erika D. Nelson

An integrative approach to health focuses on the goal of treating the mind, body and spirit all at the same time. In addition to conventional Western medicine, alternative or complementary therapies can play significant roles in maintaining health. These include everything from herbal remedies, acupuncture and massage to fitness, meditation and yoga. Scientific research is now investigating another important aspect of integrative health that centers on developing a more meaningful relationship between the patient and their practitioner.
I recently attended a presentation at the Scripps Natural Supplements conference given by Dr. David Rakel, M.D., Associate Professor and Medical Director of the University of Wisconsin Integrative Medicine Program. During his talk entitled “The Clinician as Intervention: Lessons for the Dietary Supplement Prescriber,” Dr. Rakel shared data from two recently published studies on treating the common cold, one looking at the effectiveness of Echinacea and the other the effectiveness of practitioner empathy.^1,2 In the first study, treating patients with self-reported colds with the widely used remedy Echinacea resulted in a shorter duration of one-half day and a 10% reduction in overall severity compared to placebo (neither improvement was significant; p>0.05).¹
CARE-ing Versus Standard Care
In the second study, patients with self-reported colds were randomized to either a “standard” practitioner-patient interaction, consisting of the basics such as relevant past medical history, a focused physical exam and diagnosis, or an “enhanced” practitioner-patient interaction in which physicians interacted according to the PEECE method: (P) Positive prognosis, (E) Empathy, (E) Empowerment, (C) Connection and (E) Education. Patients were then asked to assess their clinical encounter by filling out the Consultation and Relational Empathy (CARE) questionnaire.² The CARE questionnaire assesses ten areas of consultation, whether the clinician(s):

1. Made them feel at ease
2. Allowed them to “tell their story”
3. Really listened
4. Were interested in them as a whole person
5. Fully understood their concerns
6. Showed care and compassion
7. Were positive
8. Explained things clearly
9. Helped them take control
10. Helped create a plan of action

In this second study, the changes in cold severity and duration were not significantly different between the “standard” and “enhanced” interaction groups. However, patients who rated their clinical encounters with perfect CARE scores experienced a significant reduction in cold duration, by almost a full day, and a trend toward improved severity (16%) when compared to those who rated their encounters with less than perfect CARE scores. Together, the two studies suggest that when a patient with a cold experiences a truly empathetic interaction with their physician, their health tends to improve as much and perhaps more than if they were being treated with a well-known cold remedy.

A Spoonful of Empathy

While Dr. Rakel was speaking to an audience of primarily physicians, nurses and other healthcare professionals, I felt that the points he was making could be applicable for anyone interested in improving the health of others through an integrative approach. For me, the take-home message was this: the manner in which I introduce a dietary supplement to another person is extremely important. If I take the time to compassionately listen to and connect with the other person, keep a positive attitude and help that individual take control over his or her own health, the chance of that person having a beneficial experience can increase.
Maybe this isn’t a novel concept to you, but I was thrilled to learn about new, well-controlled scientific research supporting such a simple and cost-effective (read: FREE!) approach to integrative health. Here’s hoping that my next prescription reads, “Take two doses of empathy and call me in the morning!”
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¹B. Barrett et al., Echinacea for treating the common cold. Ann Intern Med. 2010; 153:769–777.
²D.P. Rakel et al., Practitioner empathy and the duration of the common cold. Fam Med. 2009; 41(7):494–501.
Dr. Nelson is a Research Scientist at Mannatech, Incorporated.