It’s important to address the patient’s concerns about side effects and long-term benefits, while building a trusting relationship with the clinician. “The patient is a partner in their own care and has to understand why you are asking them these questions.” For example, the clinician might tell their patient, “All drugs have side effects, but if we spend too much time dwelling on the side effects, you may worry more.”
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Second, Dr. Evers recommends developing more training about the placebo effect for clinicians. “It’s a hot topic right now. Along with European and federal funding support, we have been given a grant from the Dutch Arthritis Foundation to do more work in this area.”
Re-Think Your Role
Jose Pereira da Silva, MD, PhD, associate professor of medicine and rheumatology at the University of Coimbra and University of Hospital of Coimbra in Portugal, sees psychological and mental aspects of treatment as complex, multi-faceted issues that serve to underscore the mind-body connection while challenging practitioners to look beyond conventional physical disease models if they want to serve their patients’ real needs. But the psychological domains are not well defined. “Most of us are not properly trained in how to respond,” he says.
“Do you believe your role as clinician is to take care of the disease—as defined by its clinical markers—or the patient’s illness, with all of its impacts on the person’s life? I believe my concern lies with the person. I try to engage my patients in a conversation about what’s happening in their lives.” Clinicians who don’t look at these issues miss an important opportunity to make their patients feel better, he says.
Fibromyalgia, in particular, is seen by some clinicians as largely psychological, in part because good clinical markers for it don’t exist. “But we know tumor necrosis factor [TNF] travels to the brain and affects the patient in many ways, [and] anti-TNF drugs can have an antidepressive effect. Some treatments are better at improving the patient’s sense of well-being than actually improving their disease. Biology brings all of these issues together.”
Dr. da Silva illustrates the concept with the story of a young female patient who had been treated with three biologics for RA. “One day, she came to my office with her disease finally in remission. ‘Doctor,’ she said, ‘may this be because I’m in love?’”
Larry Beresford is a freelance medical journalist in Oakland, Calif.
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