In defense of the patient interview

I read an interesting article recently published in the New York Times entitled “The Conversation Placebo” in which Dr. Danielle Ofri, associate professor of medicine at NYU argues for the use of the patient interview as a treatment for certain conditions such as chronic back pain. In particular, she highlighted a Canadian study in which patients with chronic back pain were assigned to receive either electrical stimulation therapy or a sham treatment. Each treatment arm was further divided into two groups: one who received only limited conversation from the physical therapist and the other in which therapists asked open-ended questions and listened attentively to the answers. The results were fairly astounding. It was found that the shame treatment but high communication group reported more pain relief than the electrical stimulation but low communication group. In essence, communication alone was more effective than treatment alone.

While these results surprised me at first, on further reflection, I have personally witnessed how therapeutic a conversation with a physician can be. In these past couple of days alone, as I have been spending more time in the ambulatory setting, I have witnessed many such interactions play out with great effect. One clinic that stands out in particular was with Dr. HPK. As he is wrapping up his practice, many of his appointments appeared on the surface to be more of a “social visit”. However, on closer inspection, Dr. HPK is a prime example of how conversation can be used to strengthen the patient-physician relationship and even provide some therapeutic relief. Patient after patient left the clinic with a smile on their face, genuinely feeling better simply by talking with Dr. HPK. No change in medications, no additional investigations, just 30 minutes talking with a trusted physician and a good friend.

As I reflect back on my own experience with patient interviews, I have come to realize how privileged yet powerful of a role we play as medical students. As students, we often have the most time to spend with the patient and though our clinical acumen may not be as strong as those of our residents and attendings, we are trained to talk, and to listen. In light of this unique position, perhaps there is a role for training medical students to maximize the potential of the patient interview. For instance, one topic that I felt was lacking in our curriculum was counselling. While we were always guaranteed a “counselling” station on our yearly OSCE’s, I felt like I was never explicitly taught about how to conduct a therapeutic counselling session. Several tips and tricks were shared about breaking bad news, however, not much attention was given to other aspects of patient interviewing such as motivational interviewing. On a more personal level, I will learn to cherish these precious moments that we have with patients, not yet burdened by the competing demands that come with residency. I will take my time, be present, listen empathically and respond appropriately. If there is even a small chance that my conversation with a patient will have a therapeutic benefit, then that’s reason enough to try.

~CW