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Doctor/patient relationship

Physicians less likely to build a rapport with obese patients

Physicians need to discuss psychosocial and lifestyle issues with obese patients
Dr Kimberly A Gudzune

Researchers from Johns Hopkins researchers have reported that physicians build much less of an emotional rapport with their overweight and obese patients, compared with their patients of normal weight. Writing in the journal Obesity, they found that patient weight played no role in the quantity of physicians' medical questions, medical advice, counselling or treatment regimen discussions.

However, when it came to things like showing empathy, concern and understanding, the doctors were significantly more likely to express those behaviours in interactions with patients of normal weight than with overweight and obese patients, regardless of the medical topic being discussed.

"If you aren't establishing a rapport with your patients, they may be less likely to adhere to your recommendations to change their lifestyles and lose weight," said Dr Kimberly A Gudzune, an assistant professor in the Division of General Internal Medicine at the Johns Hopkins and lead author of the study. "Some studies have linked those bonding behaviors with patient satisfaction and adherence, while other studies have found that patients were more likely to change their dietary habits, increase exercise and attempt to lose weight when their physicians expressed more empathy. Without that rapport, you could be cheating the patients who need that engagement the most."

Obese patients may be particularly vulnerable to poorer physician-patient communications, write the researchers, because studies show that physicians may hold negative attitudes toward these patients. Some physicians have less respect for their obese patients, which may come across during patient encounters.

"If patients see their primary care doctors as allies, I think they will be more successful in complying with our advice," siad Gudzune,. "I hear from patients all the time about how they resent feeling judged negatively because of their weight. Yes, doctors need to be medical advisors, but they also have the opportunity to be advocates to support their patients through changes in their lives."

For the study, Gudzune and her colleagues analysed recordings of visits by 208 patients with high blood pressure who saw 39 primary care doctors in Baltimore between 2003 and 2005. The recordings showed no difference related to BMI in terms of time spent with each patient or in weight counselling.

However, when the recordings were analysed for expressed words of empathy, concern or encouragement, differences emerged. The researchers found more evidence of empathetic words and phrases - showing concern, reassurance and legitimation of patients' feelings - in interactions with patients of normal weight.

Gudzune added that physicians should be mindful of any negative attitudes, make an effort to bond, and then spend time with overweight and obese patients discussing psychosocial and lifestyle issues. If they do, physicians may find their obese patients more responsive to weight-loss counselling.

"Patients want information and treatment, but they also need the emotional support and attention that can help them through the challenges that accompany weight loss and the establishment of a healthy lifestyle," she siad.

The co-authors of the study were Johns Hopkins researchers Drs Mary Catherine Beach, Debra L Roter, and Lisa A Cooper.

The research was supported by grants from the National Institutes of Health's National Heart, Lung, and Blood Institute and the Health Resources and Services Administration.

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