The sociophysiology of caring in the doctor-patient relationship

Abstract

The emotional investment required to construct a caring doctor‐patient relationship can be justified on humane grounds. Can it also be justified as a direct physiologic intervention? Two lines of evidence point in this direction. People in an empathic relationship exhibit a correlation of indicators of autonomic activity. This occurs between speakers and responsive listeners, members of a coherent group, and bonded pairs of higher social animals. Furthermore, the experience of feeling cared about in a relationship reduces the secretion of stress hormones and shifts the neuroendocrine system toward homeostasis. Because the social engagement of emotions is simultaneously the social engagement of the physiologic substrate of those emotions, the process has been labeled sociophysiology. This process can influence the health of both parties in the doctor‐patient relationship, and may be relevant to third parties.

A humanisation approach for the management of Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome-Hypermobility Type (JHS/EDS-HT)

“…It is suggested HPs approach those with JHS/EDS-HT in a way that recognises mood and emotions (acknowledging fear) and focuses on gaining trust and understanding (Alder, 2002; Charon, 2001; Potter, Gordon, & Hamer, 2003; Todres et al, 2009). This will enable those with JHS/EDS-HT to communicate their story and to have a voice.…”

“…Those with JHS/EDS-HT have reported being prescribed treatments that provide little benefit and reduce their control of the situation (Terry et al, 2015), forcing them into being passive recipients of an intervention they do not understand. As HPs juggle the many competing elements of their roles there are benefits in encouraging those with JHS/EDS-HT to become active participants in the management of their condition (Alder, 2002; Charon, 2001; Peterkin, 2012). …”

“…The listening skills of the HP are crucial if a consultation is to be successful. It may take the whole of the first consultation for the person to offload, tell their story and say “this is who I am” (Adler, 2002; Peterkin, 2012). …”

Modern Attachment Theory: The Central Role of Affect Regulation in Development and Treatment

“…According to Pipp and Harmon (1987), ''It may be that…we are biologically connected to those with whom we have close relationships…Homeostatic regulation between members of a dyad is a stable aspect of all intimate relationships throughout the lifespan.'' At the most fundamental level, attachment represents the evolutionary mechanism by which we are sociophysiologically connected to others (Adler 2002), and nonconscious implicit interactive regulation is the central strategy that underlies all essential survival functions of the human self system (Schore 2003a, b).…”

Composing The Reflected Best-Self Portrait: Building Pathways For Becoming Extraordinary In Work Organizations

“…Supportive relationships provide security and safety for individuals to process and affirm a clearer sense of their own possibility. They may do this in part by inducing physiological changes that enable individuals to bounce back from past negative experiences, such as releases of oxytocin and endogenous opiad peptides, lowered blood pressure and allostatic load (Adler, 2002;Seeman, Singer, Rowe, Horwitz, & McEwan, 1997), and a strengthened immune system (Cohen, 2001;Ornish, 1998). Being in relationships with others can also buffer people from future setbacks and stressors in their lives (Cohen & Wills, 1985), allowing them to devote more mental energy to their own sense of possibility rather than potential failure, thus enabling revision of the RBS.…”