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[The "doctor" effect in primary care].

Alain Moreau1, Rémy Boussageon, Pierre Girier

  • 1Département de médecine générale, Université Claude Bernard Lyon 1 (69). almoreau@club-internet.fr

Presse Medicale (Paris, France : 1983)
|June 20, 2006
PubMed
Summary

The doctor effect in primary care, combining emotional and cognitive support, improves health outcomes. This requires specific doctor skills like empathy and counseling, emphasizing patient-centered care.

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Area of Science:

  • Medical Research
  • Primary Care Medicine
  • Health Psychology

Background:

  • The 'doctor effect' in primary care, encompassing non-pharmacological influences on patient outcomes, remains incompletely understood.
  • Randomized controlled trials (RCTs) offer a robust methodology for investigating such effects.

Purpose of the Study:

  • To systematically identify and characterize factors contributing to the 'doctor effect' within primary care settings.
  • To synthesize evidence from randomized controlled trials (RCTs) regarding the doctor's influence on patient health outcomes.

Main Methods:

  • A comprehensive systematic literature search was conducted using Medline database (1964-2004).
  • Keywords included 'RCT', 'doctor-patient relationship', 'doctor-patient communication', 'knowledge', 'skill', 'attitude', 'non-pharmacologic effectiveness', and 'primary care'.
  • Inclusion criteria focused on original RCT reports, reviews, and meta-analyses.

Main Results:

  • Ten RCTs and one meta-analysis demonstrated that a combination of emotional and cognitive care consistently yields positive health outcomes.
  • Key contributing factors identified include doctor's empathy, reassurance, explanation, and counseling skills.
  • These skills facilitate influencing patient beliefs, promoting behavioral change, and managing thoughts/emotions, supporting a patient-centered approach.

Conclusions:

  • Effective primary care necessitates integrating specific doctor attitudes and relational skills, such as empathy and counseling.
  • Medical education should prioritize training in these relational skills to enhance treatment effectiveness.
  • Future research, including both qualitative and quantitative studies (RCTs), is needed to address the heterogeneity of general practice settings.

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