Improving Healthcare by Harnessing the Social Context
Anyone who has been to the doctor recognizes that medical diagnoses and treatments are embedded in a social context. Patients are influenced not only by what tests are performed and what treatments are suggested, but how the doctor communicates the results of these tests makes recommendations, and engages with patients. How can we use the social context to improve healthcare?
Research that unpacks elements of the social context suggests many possibilities. Kate Sweeny explores how patients cope while waiting for the results of medical tests. There are two ways that clinics return results – open-ended (e.g., “We’ll call you when the results are in”) or close-ended (e.g., “We’ll give you the results next Wednesday”). The close-ended approach results in longer wait times – but may reduce anxiety among patients. Perhaps simply asking patients how they would prefer to hear about test results could improve this painful process.
Andrew Geers demonstrates that choice can enhance a treatment’s effectiveness. In one study, participants were blasted with uncomfortable bursts of noise. In one condition, participants could choose to view one of two colors on a computer screen that they were told would help to make the sounds less unpleasant. In another condition, participants were assigned a color to view and given no choice. When participants were able to choose the color they could view before listening to unpleasant noises – actively selecting their treatment to relieve the pain – this treatment was more successful. Facilitating feelings of patient choice and control might positively impact the course of some treatments.
Positive interactions with doctors can impact a patient’s physical health, as my colleagues Alia Crum, Parker Goyer, and I show. Participants came into our lab for a histamine skin prick test that creates a mild allergic reaction. In one condition, the provider who conducted the test was warm and friendly, and seemed to know what she was doing. In another condition, the provider was colder and distant, and stumbled through parts of the exam, even putting a blood pressure cuff on upside down. After the skin prick test, the provider put a cream with no active ingredient on the reaction, and either set positive expectations (“The cream is an antihistamine that will reduce the reaction”), or negative expectations (“The cream is a histamine agonist that will increase the reaction”). Like past research on placebo and nocebo effects, the cream affected the size of the reaction in line with the expectations that had been set – but only when the provider had acted warmly and competently. When the provider seemed colder and less competent, expectations had no effect on the size of the allergic reaction. Warmth and competence, rather than just something that is “nice to have,” are an important part of quality medical care because they can impact a patient’s physical health.
In fact, believing that the patient-provider relationship matters for health can change how doctors interact with patients – and vice versa. In a recent survey, Kari Leibowitz and Alia Crum show that patients with the mindset that a good patient-provider relationship enhances health (agreeing that “For doctors, forming relationships with patients improves how patients respond physiologically to treatment”) reported engaging more in interactions with physicians. In contrast, doctors who believe that forming relationships with patients undermines healthcare by burning out physicians faster reported spending less time caring for their patients. Changing these mindsets might be fruitful. As Kari Leibowitz explained, “Mindsets could be leveraged in future interventions to strengthen the patient-provider relationship to improve patient health outcomes and physician well-being.” Doctors – and patients - may deliberately harness the social context to improve the quality of medical care.
Lauren Howe is a 6th year PhD candidate in social psychology at Stanford University and the Shaper Family Stanford Interdisciplinary Graduate Fellow. Her research interests include social acceptance and social rejection, trust in experts, and patient-physician interactions.
From the Symposium, Harnessing Psycho-social Forces in Healthcare held during the 2017 SPSP Annual Convention in San Antonio, TX.