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Monday, April 25, 2016

Shame and Blame in the Therapeutic Relationship

Ami Schattner
JAMA Intern Med. Published online April 04, 2016.

Here is an excerpt:

[The physician-patient relationship] requires full commitment providing information, empathy, and bonding obligatory for patient-centeredness, patient satisfaction, trust, and adherence which translate into "hard" health outcomes. Because clinical care is strongly dependent on this human interaction, it is also susceptible to inherent biases (mostly unintentional) that are one major cause of variation in care. In this context, providers' reactions to certain patients may involve negative feelings adversely affecting the degree of effort invested in their care, diagnostic accuracy, treatment decisions, and level of communication, empathy and support. Stigmatized patients may get different (less than optimal) care, just as "nice" patients may be preferred and receive better care. Instead of empathy and bonding, which have a positive impact on outcomes, censure, absent compassion, diminished bonding, and poor support toward patients who caused their own wretched state are likely, as well as actual variation in care, all compromising patient outcomes. For example, poor provider's empathy and bonding on the part of the clinician was linked to low patient adherence and may be associated with actual discrimination and rationing.

The article is here.