How “Medically Superfluous” Factors Help Patients Heal

An article in the BMJ1 written by three members of the Stanford community argues that doctors’ influence on their patients is affected by two factors that most doctors don’t take into consideration: patients’ mindset and the social context. After defining and describing these factors, the authors offer “recommendations for research, education, and health systems.”

Making Mindset Matter” was written by Alia Crum, PhD (assistant professor, psychology),Kari A. Leibowitz (doctoral candidate in psychology), and Abraham Verghese, MD (vice chair of medicine). Its short summary in the BMJ suggests that health outcomes can be improved by acting upon “the growing evidence about the influence of patient mindset and social context.”

While granting the randomized clinical trial (RCT) its position as “a good and rigorous standard for testing the efficacy of new medications,” the authors contend that the RCT ignores both the social and the psychological elements that underlay placebo effects and influence treatment. The authors argue that while RCT considers mindset and the social context “medically superfluous,” they are, in fact, essential to patient outcomes.

Patients’ mindsets (or beliefs/expectations) that they will heal “can account for clinically significant benefit in an estimated 60-90% of conditions,” while social contexts, which shape mindsets, “include explicit expectations set by the doctor and more subtle social or environmental factors.” The doctor-patient relationship is one element of social context while medical ritual is another.

Thus the doctor who declares that a particular medication will help the patient improve is pivotal, including the words he or she uses and the white coat worn, as well as certain factors about the medication, such as its color, label, and price. Similarly, in a randomized trial a doctor’s empathy was associated with briefer colds with less severe symptoms.

 Improved understanding of the ability of the social context and patients’ mindsets to evoke healing properties in the body can be an extraordinary resource for health and healing.

After providing examples of instances in which patients’ mindsets and social contexts were positively or negatively affected by their physicians, the authors propose some changes to take advantage of the “potential benefits of psychological and social forces in healing.” In the research arena, they propose interdisciplinary investigations “that manipulate psychosocial elements in the context of existing medical practices.” From the educational standpoint, they suggest that medical students and residents need additional training that will show them how to “harness their personal strengths to connect with diverse patients,” influencing patients in ways that will help them “choose optimal mindsets and shape the social context to their advantage.” Finally, they authors propose system reform to “align with and promote effective use of psychosocial elements in healthcare.”

They conclude by emphasizing the need to use all available tools to improve patient health. Two tools that have been ignored in the past, social context and patients’ mindsets, need to be understood better as resources “for health and healing. We need,” they write, “to open our own minds to that possibility.”

1Crum AJ, Leibowitz KA, Verghese A. Making mindset matter. BMJ 2017;356:j674 February 15.