A review of CARE scores measuring the effects of empathy in the clinical encounter found that perfect scores predicted the duration of subsequent illness. Although not statistically significant, perfect scores also showed a trend towards improved severity and the degree of rise of IL-8 levels from nasal wash. Including potential confounders did not reduce the strength of the observed predictive relationship.
A patient rating of a perfect score on the CARE instrument at the time of consultation was associated with a 0.91 day (7.10 vs. 8.01) shorter duration of illness, and trends in severity and IL-8: a 16% reduction in overall cold severity (AUC 240.4 vs. 284.5), and more than double the rise in the immune biomarker IL-8 (562.2 vs. 220.1).
To help determine if these associations are the result of clinician empathy or the unique characteristics of patients giving perfect scores, we looked at individual characteristics. Those who gave perfect scores were more likely to be older, non-white, and to have completed less education. However, these attributes did not predict illness severity or duration. We hypothesized that those who were more optimistic or reported less stress would be more likely to give perfect scores. When stress and optimism were included, a perfect CARE score was still associated with a shorter cold and less severe symptoms. Reporting a perfect CARE score did not significantly correlate with quality of life ratings (SF-8) or ratings of personal health (i.e. Feeling Thermometer, How sick are you?) at enrollment. We were unable to find unique characteristics of individuals giving perfect scores that could account for the associations with illness duration, severity and IL-8 levels. Even after controlling for possible confounders, the association of a perfect CARE score with reduced duration and severity remains ().
We therefore conclude that the empathetic interaction between patient and clinician may indeed influence subsequent illness.
Why did these changes only occur within patients who gave perfect CARE scores? We were not able to correlate sub-perfect scores with these outcomes, hence a graduated “dose-response relationship” was not seen. A possible explanation for this lack of dose-response is that if a “connection” happened in the consultation, it is likely that the patient gave a perfect score. Anything less than perfect may not correlate with a “connection” taking place where empathy was expressed or felt. This may suggest that the perception of empathy by patients may be more of an “on or off” phenomenon than a graduated response. We either feel empathy or we don’t.
The perfect CARE score group was also associated with a more robust IL-8 response at 48 hours after intake than those who gave a non-perfect score. Inflammatory/immune cytokines (i.e., IL-8) released in response to viral infections indicate an active immune response to the offending organism. 44–46
Our observation that IL-8 rises faster among those giving perfect CARE scores links the subjective rating of a positive emotion (empathy) with an objective measure (IL-8). Specific negative emotional states such as stress and depression can increase susceptibility to the common cold, suggesting that negative emotions may have a negative effect on immune function.47–49
Data presented here suggests that a consultation rated high in empathy, a positive emotion, is associated with an enhanced immune response and a shorter illness. These findings suggest that IL-8 holds promise for future research in relation to empathy’s effect on immune pathways.
The positive benefits of perceived empathy on the common cold can be put into perspective when compared to anti-viral studies showing similar modest effect sizes. In order for a drug to be beneficial for a self-limited illness such as the common cold, it needs to show efficacy, ease of dosing and few side effects.50
The best effect from a drug studied to date (pleconaril) also reduced the duration by about one day but worked only for picornavirus-associated colds and caused nausea and diarrhea.50,51
Empathy has a similar effect without side effects in all-cause colds and was found beneficial after only one dose of human empathy.
The findings here are tentative and in need of replication. Until then, including empathy in the clinical encounter has little potential for harm and has positive influences that extend beyond the medical consultation. A “connection” also enhances continuity and builds a foundation for relationship-centered primary care within the patient’s medical home.