When Your Doctor “Gets It” and “Gets You”: The Critical Role of Competence and Warmth in the Patient–Provider Interaction

Abstract

Background: Research demonstrates that the placebo effect can influence the effectiveness of medical treatments and accounts for a significant proportion of healing in many conditions. However, providers may differ in the degree to which they consciously or unconsciously leverage the forces that produce placebo effects in clinical practice. Some studies suggest that the manner in which providers interact with patients shapes the magnitude of placebo effects, but this research has yet to distill the specific dimensions of patient–provider interactions that are most likely to influence placebo response and the mechanisms through which aspects of patient–provider interactions impact placebo response. Methods: We offer a simplifying and unifying framework in which interactions that boost placebo response can be dissected into two key dimensions: patients’ perceptions of competence , or whether a doctor “gets it” (i.e., displays of efficiency, knowledge, and skill), and patients’ perceptions of warmth , or whether a doctor “gets me” (i.e., displays of personal engagement, connection, and care for the patient). Results: First, we discuss how this framework builds on past research in psychology on social perception of competence and warmth and in medical literature on models of effective medical care, patient satisfaction, and patient–provider interactions. Then we consider possible mechanisms through which competence and warmth may affect the placebo response in healthcare. Finally, we share original data from patients and providers highlighting how this framework applies to healthcare. Both patient and provider data illustrate actionable ways providers can demonstrate competence and warmth to patients. Discussion: We conclude with recommendations for how researchers and practitioners alike can more systematically consider the role of provider competence and warmth in patient–provider interactions to deepen our understanding of placebo effects and, ultimately, enable providers to boost placebo effects alongside active medications (i.e., with known medical ingredients) and treatment in clinical care.

What Should Clinicians Tell Patients about Placebo and Nocebo Effects? Practical Considerations Based on Expert Consensus

“…Training could, moreover, emphasize that different patients might require different information, and that placebo and nocebo effects can operate differently for different conditions. Finally, an emphasis should be placed on what clinicians can do to maximize placebo effects and minimize nocebo effects (i.e., deploying strategies such as optimizing verbal and nonverbal communication [15,[30][31][32][33][43][44][45][46][47][48][49][50][51][52]).…”

“Placebo by Proxy” and “Nocebo by Proxy” in Children: A Review of Parents' Role in Treatment Outcomes

“…This could include assessment of parental beliefs, mindset attitudes, and expectations guiding their perceptions of the treatment received by their child. Further, it is conceivable that perceptions of competence and empathy also influence placebo effects in this setting (97,98) whereby some parents are better able to enhance placebo effects via competence/empathy cues. The scarce data available brings the necessity in future research of placebo studies and parents' role in their children's treatment.…”

“It’s way more than just writing a prescription”: A qualitative study of preferences for integrated versus non-integrated treatment models among individuals with opioid use disorder

“…Strong and trusting patient-provider relationships can reduce the impact of privacy concerns [107,108], so the negative relationships described by some patients may intensify these privacy concerns. In addition, patients rate emphatic providers as more competent [109,110]. Therefore, considering interventions and methods to improve the patient-provider relationship may support patient engagement in integrated treatment.…”