The real p(atient) value
The significance of patient perspectives: empathy and better healthcare
journal, until now I have remained a data5 point, but I am a person. Please allow me to introduce myself, my name is Sharon Roman, and 20 years ago, I was diagnosed with clinically definite multiple sclerosis.
Funding The authors have not declared a speci c grant for this research from any funding agency in the public, commercial or not-for-pro t sectors.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Commissioned; internally peer reviewed.
© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.
To cite Roman S. J Neurol Neurosurg Psychiatry 2019;90:371.
Received 23 January 2019 Accepted 30 January 2019
Medical literature abounds with the names of doctors who have made significant contributions in their field of study. Their quest for better healthcare has generated enormous amounts of bar graphs, pie charts and scatter plots made of invis- ible faces and anonymous lives. Any hint of identity carefully erased. But we, the anonymous, have valuable contributions to make as well, with knowledge of our own—personal experience and a different perspective of healthcare. Knowledge and identities not found in textbooks and, until now, not featured in this journal.
Being a case study, randomised, assigned and reduced to a p value, while serving the greater good of medicine, also contributes to distancing patients. The loss of empathy and dehumanisation1 in medicine is real. Academic journals can add to this alien- ation and further insulate clinicians and researchers from the people who have swallowed, injected or undergone invasive or harmful treatments in hopes of finding a cure, or relief. I was once one.
Academic journals can also play a direct role in helping clinicians and researchers see patients for who we are—real people, the person in the queue ahead of you, your neighbour. We must hold fast the view that best practice is not just for patients,
JNNP, BMJ Publishing Group, London, UK Correspondence to Sharon Roman; firstname.lastname@example.org
it also includes patients. Our involvement does not diminish a journal’s content or impact factor. That belittles the value of personal experience and doctors’ ability to learn from it.
Clinicians who are interested in a patient’s perspective are more likely to have empathy, and researchers are more likely to engage patients of their own voli- tion. It must be realised that the function of empathy2 is not merely to label emotional states, but to recognise what it feels like to experience something. There can be no empathy without shared perspective.
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An empathic connection can also make practising medicine more rewarding. Physicians who allow their patients to emotionally move them enrich their own experience of doctoring, and numerous studies have shown that patients who
are treated by doctors who score higher
on empathy experience improved health3 outcomes.4 Empathy offers guilt-free selfish outcomes for both doctor and patient. Expert opinion coupled with patient perspective is a winning combina- 2 tion for all, and seeing the person behind
the disease personalises healthcare and 4 science.
The hidden significance of the p value 4 is the patient, and the null hypothesis is that our perspective can effect change 5 for better healthcare. While I have likely been a part of studies published in this
► http://dx.doi.org/10.1136/jnnp-2019-320453 J Neurol Neurosurg Psychiatry 2019;90:371.
1 Haque OS, Waytz A. Dehumanization in medicine: causes, solutions, and functions. Perspect Psychol Sci 2012;7:176–86.
Halpern J. What is clinical empathy? J Gen Intern Med 2003;18:670–4.
Decety J, Fotopoulou A. Why empathy has a bene cial impact on others in medicine: unifying theories. Frontiers in Behavioural Neuroscience 2014;8. Canale SD, Louis DZ, Maio V, et al. What is clinical empathy. Academic Medicine 2012;87:1243–9. Kingwell E, van der Kop M, Zhao Y, et al. Relative mortality and survival in multiple sclerosis: ndings from British Columbia, Canada. J Neurol Neurosurg Psychiatry 2012;83:61–6.
Roman S. J Neurol Neurosurg Psychiatry April 2019 Vol 90 No 4
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J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp-2019-320455 on 9 April 2019. Downloaded from http://jnnp.bmj.com/ on 6 June 2019 by guest. Protected by copyright.