It used to be called ‘good bedside manners’. The term is an umbrella for a range of attitudes and behaviours including compassion, empathy and conveying positive messages. What could be more obvious than the assumption that good bedside manners are better than bad ones?
But as sceptics, we need to doubt obvious assumptions! Where is the evidence? we need to ask. So, where is the evidence that positive messages have any clinical effects? A meta-analysis has tackled the issue, and the results are noteworthy.
The researchers aimed to estimate the efficacy of positive messages for pain reduction. They included RCTs of the effects of positive messages. Their primary outcome measures were differences in patient- or observer reported pain between groups who were given positive messages and those who were not. Of the 16 RCTs (1703 patients) that met the inclusion criteria, 12 trials had sufficient data for meta-analysis. The pooled standardized effect size was −0.31 (95% CI −0.61 to −0.01, P = 0.04, I² = 82%). The effect size remained positive but not statistically significant after we excluded studies considered to have a high risk of bias (standard effect size −0.17, 95% CI −0.54 to 0.19, P = 0.36, I² = 84%). The authors concluded that care of patients with chronic or acute pain may be enhanced when clinicians deliver positive messages about possible clinical outcomes. However, we have identified several limitations of the present study that suggest caution when interpreting the results. We recommend further high quality studies to confirm (or falsify) our result.
The 1st author of this paper published a comment in which he stated that our recent mega-study with 12 randomized trials confirmed that doctors who use positive language reduce patient pain by a similar amount to drugs. Other trials show that positive messages can:
• help Parkinson’s patients move their hands faster,
• increase ‘peak flow’ (a measure of how much air is breathed) in asthma patients,
• improve the diameter of arteries in heart surgery patients, and
• reduce the amount of pain medication patients use.
The way a positive message seems to help is biological. When a patient anticipates a good thing happening (for example that their pain will go away), this activates parts of the brain that help the body make its own drugs like endorphins. A positive doctor may also help a patient relax which can also improve health.
I am not sure that this is entirely correct. When the authors excluded the methodologically weak and therefore unreliable studies, the effect was no longer significant. That is to say, it was likely due to chance.
And what about the other papers cited above? I am not sure about them either. Firstly, they do not necessarily show that positive messages are effective. Secondly, there is just one study for each claim, and one swallow does not make a summer; we would need independent replications.
So, am I saying that being positive as a clinician is ineffective? No! I am saying that the evidence is too flimsy to be sure. And possibly, this means that the effect of positive messages is smaller than we all thought.
10 Responses to How effective are positive messages?
Leave a Reply
This site uses Akismet to reduce spam. Learn how your comment data is processed.
So following the logic of this post, one of the main sticks used to beat down positive results from acupuncturists (and others) – ‘it’s all just bedside manner making people feel better’ – can’t be used now?
has anyone ever tried to use the ‘stick’ “it’s due to the positive messages from the acupuncturist”?
Of course, within the comments of this site for example.
please show me
The search bar doesn’t seem to look within the comments section of the site so it’s a bit tricky finding examples, but here are a couple:
http://edzardernst.com/2014/04/acupuncture-for-surgical-conditions/
‘Like most CAM, acupuncture seems to benefit the patient by providing them time with a sympathetic other.’ (Frank O, 9/4/14, 08:14)
http://edzardernst.com/2013/03/alternative-practitioners-treat-the-root-causes-of-disease/
‘Now, which is it that is working? The tender loving care and good advice as long as it lasts, or the archaic sympathetic magic based on prescientific imaginary “elements” and bodily structures that no one can find – and a therapy modality that involves practically arbitrary injurious interventions that involve a risk of serious consequences like in the recent case of a Norwegian succumbing to sepsis after the palm of his hand was used as pin cushion?’ (Bjorn, 2/4/17, 11.23)
positive message???
I don’t think so!
Google Site Search does: https://www.google.co.uk/?q=site:http://edzardernst.com/+%22Tom+Kennedy%22
There is a difference between a ‘positive message’ and a ‘sympathetic manner’ as should be obvious, one can deliver bad news in a sympathic manner after all.
What I said ‘bedside manner’ – see your own opening paragraph for a description of the ‘range of attitudes and behaviours’ under discussion here, which I think are clearly invoked in the quotes I found.
perhaps you should read further than the 1st paragraph:
It used to be called ‘good bedside manners’. The term is an umbrella for a range of attitudes and behaviours including compassion, empathy and conveying positive messages. What could be more obvious than the assumption that good bedside manners are better than bad ones?
But as sceptics, we need to doubt obvious assumptions! Where is the evidence? we need to ask. So, where is the evidence that positive messages have any clinical effects? A meta-analysis has tackled the issue, and the results are noteworthy.