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Cited by 16Empathy and Medical EducationPatient-Provider Communication in HealthcareMusculoskeletal pain and rehabilitation

Empathy in Medicine Osteopathic and Allopathic Physician Interpersonal Manner, Empathy, and Communication Style and Clinical Status of Their Patients: A Pain Registry–Based Study

Open access
Licciardone, John C., Schmitt, Monika E., Aryal, Subhash·2019·Journal of Osteopathic Medicine
DOI 10.7556/jaoa.2019.092
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Abstract

Context: Comparisons of osteopathic physicians (ie, DOs) and allopathic physicians (ie, MDs) on interpersonal manner, including empathy and communication style, have been limited by such methodologic issues as self-assessment and a focus on medical students rather than practicing physicians. Objective: To compare perceptions of the interpersonal manner, empathy, and communication style of DOs and MDs and corresponding clinical measures reported by their patients. Methods: A cross-sectional study of adults with subacute or chronic low back pain was conducted within the PRECISION Pain Research Registry from April 2016 through December 2018. A total of 313 patients having their physician for 1 year or longer reported sociodemographic and clinical characteristics, including use of nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids for low back pain. Using validated research instruments, they also reported perceptions of their physician's interpersonal manner, empathy, and communication style and clinical measures of pain catastrophizing, pain self-efficacy, low back pain intensity, back-related disability, and deficits in quality of life relating to sleep disturbance, pain interference with activities, anxiety, depression, and low energy/fatigue. Results: Patients treated by DOs were less likely to be using NSAIDs (odds ratio [OR], 0.60; 95% CI, 0.36-0.997) or opioids (OR, 0.57; 95% CI, 0.32-0.998) than patients treated by MDs. Patients treated by DOs reported lesser pain catastrophizing (mean, 12.5; 95% CI, 10.1-15.0 for DOs vs 18.1; 95% CI, 16.3-19.9 for MDs; P<.001) and greater pain self-efficacy (mean, 39.5; 95% CI, 36.3-42.8 for DOs vs 35.3; 95% CI, 33.4-37.3 for MDs; P=.03). Correspondingly, patients treated by DOs reported lesser back-related disability (mean, 11.2; 95% CI, 9.9-12.5 for DOs vs 13.5; 95% CI, 12.8-14.3 for MDs; P=.002) and a trend toward lesser deficits in quality of life. Patients reported more favorable perceptions of DOs on interpersonal manner (mean, 4.3; 95% CI, 4.2-4.5 for DOs vs 4.0; 95% CI, 3.9-4.2 for MDs; P=.01) and empathy (mean, 41.2; 95% CI, 39.1-43.3 for DOs vs 38.0; 95% CI, 36.5-39.5 for MDs; P=.02). Conclusion: The mechanisms underlying lesser use of NSAIDs and opioids, superior clinical status measures, and more favorable perceptions of physician interpersonal manner and empathy reported by patients treated by DOs warrant further investigation.

AI snapshot

Written from the paper’s full text.

TL;DR

In a cross-sectional pain registry study, patients treated by osteopathic physicians (DOs) reported more favorable physician interpersonal manner and empathy, less NSAID/opioid use, and some better low back pain clinical status measures than patients treated by allopathic physicians (MDs). The mechanisms behind these differences remain unclear and warrant further investigation.

Key findings

  • Among 313 adults with subacute or chronic low back pain, patients treated by DOs were less likely to be using NSAIDs (OR, 0.60; 95% CI, 0.36-0.997) or opioids (OR, 0.57; 95% CI, 0.32-0.998) than patients treated by MDs.
  • Patients treated by DOs reported lesser pain catastrophizing (mean, 12.5; 95% CI, 10.1-15.0 vs 18.1; 95% CI, 16.3-19.9; P<.001), greater pain self-efficacy (mean, 39.5; 95% CI, 36.3-42.8 vs 35.3; 95% CI, 33.4-37.3; P=.03), and lesser back-related disability (mean, 11.2; 95% CI, 9.9-12.5 vs 13.5; 95% CI, 12.8-14.3; P=.002), with a trend toward lesser quality-of-life deficits.
  • DOs were perceived more favorably on interpersonal manner (mean, 4.3; 95% CI, 4.2-4.5 vs 4.0; 95% CI, 3.9-4.2; P=.01) and empathy (mean, 41.2; 95% CI, 39.1-43.3 vs 38.0; 95% CI, 36.5-39.5; P=.02).
  • Patients treated by DOs more often reported spinal manipulation use (60.9% vs 37.2%; P<.001).

Methods

  • Cross-sectional study within the PRECISION Pain Research Registry from April 2016 through December 2018; 313 of 488 registry patients (64.1%) were eligible, including 87 treated by DOs and 226 by MDs, all adults aged 21-79 with subacute or chronic low back pain and a physician for 1 year or longer.
  • Validated patient-reported instruments measured physician interpersonal manner (18-item Patient Satisfaction Questionnaire), empathy (Consultation and Relational Empathy measure), and communication style (Communication Behavior Questionnaire), plus clinical measures including pain catastrophizing, pain self-efficacy, low back pain intensity, back-related disability, and PROMIS-29 SPADE quality-of-life deficits.
  • Analyses used descriptive statistics and contingency table methods with odds ratios and 95% CIs or t tests, with hypotheses tested at the .05 significance level.

Limitations

  • The paper states that the greatest limitations were the observational cross-sectional design and lack of randomization; the cross-sectional design did not enable definitive assessment of causation because of unclear temporal relationship between osteopathic medical care exposure and patient clinical status.
  • The authors state they mitigated the temporal limitation by including only patients who had their physician for at least 1 year, and that lack of randomization did not appear to be an important source of bias because DO- and MD-treated patients did not differ significantly on important baseline variables.
  • Evident from the text: the study relies on patient-reported perceptions and clinical measures rather than direct observation or objective measurement of physician empathy/communication, and the authors call for longitudinal follow-up to clarify mechanisms.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.7556/jaoa.2019.092

Cites

26 of 26 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

10 of 21 cited sources checked · 5 supported · 0 flagged · accuracy not yet measured

  • Study design and conductcitation

    The inclusion criteria for chronic low back pain duration and frequency match the case definition established by the NIH Task Force on Research Standards for Chronic Low Back Pain.

    “The inclusion criteria for chronic low back pain duration and frequency described herein match the case definition established by the National Institutes of Health (NIH) Task Force on Research Standards for Chronic Low Back Pain. 10”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [10] Deyo RA , DworkinSF, AmtmannD, et al. Report of the NIH Task Force on research standards for chronic low back pain. J Pain. 2014;15(6):569-585. doi:10.1016/j.jpain.2014.03.005 source
  • Premisecitation

    There is reason to believe that DOs have a unique approach to managing musculoskeletal pain that transcends the use of osteopathic manipulative treatment or drug therapy.

    “However, there is reason to believe that osteopathic physicians (ie, DOs) have a unique approach to managing musculoskeletal pain that transcends the use of osteopathic manipulative treatment or drug therapy.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [2] Licciardone, 2015, A national study of primary care provided by osteopathic physicians, J Am Osteopath Assoc source

      The Discussion reports a distinctive approach to low back pain: osteopathic physicians provided greater continuity of care, made fewer referrals, and relied less on medication. That supports a difference beyond drug therapy, but the paper did not collect OMT-use data and found no clearly distinctive pattern for neck pain, so it does not establish the broader claim about musculoskeletal pain. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
  • Premisecitation

    Comparative studies of empathy have focused on osteopathic and allopathic medical students.

    “Comparative studies of empathy have focused on osteopathic and allopathic medical students.”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [3] Kimmelman, 2012, Empathy in osteopathic medical students: a cross-sectional analysis, J Am Osteopath Assoc
    • cites [4] Calabrese, 2013, Correlates and changes in empathy and attitudes toward interprofessional collaboration in osteopathic medical students, J Am Osteopath Assoc source
    • cites [5] Chen, 2007, A cross-sectional measurement of medical student empathy, J Gen Intern Med source

      The Methods and Results describe a comparison of empathy across class years at one medical school, and the Discussion reviews other comparisons among medical students. No passage in our copy identifies comparative studies focused on osteopathic versus allopathic students; searches for those terms found none. (LLM, conf=0.72)

      Experimental — accuracy not yet measured
  • Findingown data

    Patients reported more favorable perceptions of DOs on interpersonal manner than of MDs (mean, 4.3; 95% CI, 4.2-4.5 vs 4.0; 95% CI, 3.9-4.2; P=.01).

    “Patients reported more favorable perceptions of DOs on interpersonal manner (mean, 4.3; 95% CI, 4.2-4.5 for DOs vs 4.0; 95% CI, 3.9-4.2for MDs; P=.01)”
    Quote in the paperSubstantial claim
  • Findingown data

    Patients treated by DOs were more likely to have been treated with spinal manipulation for low back pain than patients treated by MDs.

    “Patients treated by DOs had more favorable cigarette smoking histories, were less likely to be bothered by widespread pain, and were more likely to have been treated with spinal manipulation for low back pain.”
    • Also stated in: § Discussion · plain
      “Treatment Spinal manipulation 53 (60.9) 84 (37.2) <.001”
    Quote in the paperNot a substantial claim
  • May combine two claims. 8
  • Classified as probably not a substantial claim. 5

  • May combine two claims.

    Interpretationown data

    Patients treated by DOs more often reported low back pain management in accord with current clinical practice guidelines, including greater use of nonpharmacologic treatments (eg, spinal manipulation) and lesser use of NSAIDs and opioids, than patients treated by MDs.

    “Our findings demonstrate that patients treated by DOs more often reported low back pain management that was in accord with current clinical practice guidelines, including greater use of nonpharmacologic treatments (eg, spinal manipulation) and lesser use of NSAIDs and opioids, than patients treated by MDs.”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [23] Dowell, 2016, CDC guideline for prescribing opioids for chronic pain — United States, 2016. source

      The Recommendations section supports nonpharmacologic treatment for chronic low back pain, and the guideline cautions against long-term opioid use for that condition. But the Effectiveness of Nonpharmacologic and Nonopioid Pharmacologic Treatments section says NSAIDs are recommended as first-line treatment for low back pain; it does not establish that less NSAID use is more guideline-concordant or specifically recommend spinal manipulation. The DO–MD comparison is presented as the citing authors’ own finding, not as a finding of this guideline. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [24] Qaseem, 2017, Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians, Ann Intern Med source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Another study of self-reported empathy found a significant difference in favor of osteopathic medical students, but only among third-year students in comparison with an externally acquired control group.

    “Alternatively, another study of selfreported empathy found a significant difference in favor of osteopathic medical students, 4 but only among thirdyear students in comparison with an externally acquired control group.5”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [4] Calabrese, 2013, Correlates and changes in empathy and attitudes toward interprofessional collaboration in osteopathic medical students, J Am Osteopath Assoc source
    • cites [5] Chen, 2007, A cross-sectional measurement of medical student empathy, J Gen Intern Med source

      The Study Design and Results describe self-reported empathy scores for Boston University medical students, including third-year students, so the paper could supply an external comparison group. Neither those sections nor the Discussion report a comparison with osteopathic students or a significant difference favoring them only in the third year. The cited paper therefore supports the comparison data, not the comparative finding. (LLM, conf=0.82)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisereasoning

    Studies of medical student empathy are limited by self-assessment, non-generalizable single-institution comparisons, and lack of measures reflecting actual patient encounters with practicing physicians.

    “Such studies of medical student empathy are limited in several important ways: they measure only the student's self-assessment of empathy; the comparisons involve students from single osteopathic and allopathic institutions that are not generalizable to the broader populations of osteopathic and allopathic medical students; and they do not provide measures of empathy that reflect actual patient En”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [3] Kimmelman, 2012, Empathy in osteopathic medical students: a cross-sectional analysis, J Am Osteopath Assoc
    • cites [4] Calabrese, 2013, Correlates and changes in empathy and attitudes toward interprofessional collaboration in osteopathic medical students, J Am Osteopath Assoc source
    • cites [5] Chen, 2007, A cross-sectional measurement of medical student empathy, J Gen Intern Med source

      The Discussion says the study used a self-reported empathy scale that does not measure behavior, and that it was conducted at one medical school. Its measurements therefore do not reflect actual patient encounters with practicing physicians. But the paper does not compare osteopathic and allopathic institutions, and it says its findings may generalize to schools with a similar structure; it does not support that specific non-generalizability claim. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Recommendations of the NIH Task Force on Research Standards for Chronic Low Back Pain were adopted in conducting the study, including use of the case definition for chronic low back pain and clinical measures pertaining to low back pain intensity, back-related disability, and quality of life.

    “Recommendations of the NIH Task Force on Research Standards for Chronic Low Back Pain were adopted in conducting our study, including use of the case definition for chronic low back pain and clinical measures pertaining to low back pain intensity, back-related disability, and quality of life.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [10] Deyo RA , DworkinSF, AmtmannD, et al. Report of the NIH Task Force on research standards for chronic low back pain. J Pain. 2014;15(6):569-585. doi:10.1016/j.jpain.2014.03.005 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The study's observational cross-sectional design and lack of randomization were its greatest limitations.

    “The greatest limitations of the study were its observational cross-sectional design and lack of randomization.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    A study found that allopathic medical students reported greater empathy than osteopathic medical students in first- and second-year classes, but not in third- and fourth-year classes.

    “A study 3 that compared self-reported student empathy levels found that allopathic medical students reported greater empathy than osteopathic medical students in the firstand second-year classes, but not in the third-and fourth-year classes.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] Kimmelman, 2012, Empathy in osteopathic medical students: a cross-sectional analysis, J Am Osteopath Assoc

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Study design and conductreasoning

    Patients were recruited from a community-based pain research registry, thereby enhancing the representativeness of the study population.

    “Patients were recruited from a community-based pain research registry, thereby enhancing the representativeness of the study population.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The investigators of the Maine Osteopathic Outcomes Study concluded that DOs were easily distinguishable from MDs by their verbal interactions with patients, particularly those having low back pain, but called for larger studies to replicate their findings.

    “The investigators concluded that DOs were easily distinguishable from MDs by their verbal interactions with patients (particularly those having low back pain) but called for larger studies to replicate their findings.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [7] Carey, 2003, Do osteopathic physicians differ in patient interaction from allopathic physicians? an empirically derived approach, J Am Osteopath Assoc

  • May combine two claims.

    Study design and conductown data

    Lack of randomization did not appear to be an important source of bias because patients treated by DOs or MDs were not significantly different on important baseline variables, including sociodemographic characteristics, diagnosed medical conditions, chronicity of low back pain, or previous low back surgery.

    “Lack of randomization did not appear to be an important source of bias, as patients treated by DOs or MDs were not significantly different from one another on important baseline variables, including sociodemographic characteristics, diagnosed medical conditions, chronicity of low back pain, or previous low back surgery.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    A randomized controlled trial found immediate improvements in ratings of sadness, anger, and frustration among patients with low back pain interviewed with a standardized validating communication style, but not in patients interviewed with an invalidating communication style.

    “A randomized controlled trial found immediate improvements in ratings of sadness, anger, and frustration among patients with low back pain who were interviewed with a standardized validating communication style, but not in patients interviewed with an invalidating communication style.6”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [6] Vangronsveld, 2012, The effect of validating and invalidating communication on satisfaction, pain and affect in nurses suffering from low back pain during a semi-structured interview, Eur J Pain source

  • May combine two claims.

    Premiseown data

    In the Maine Osteopathic Outcomes Study, DOs more often demonstrated a communication style reflective of osteopathic principles of practice than MDs, with the greatest DO-MD difference in communication observed in patients with low back pain.

    “Osteopathic physicians more often demonstrated a communication style that was reflective of osteopathic principles of practice, with the greatest DO-MD difference in communication observed in patients with low back pain.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [7] Carey, 2003, Do osteopathic physicians differ in patient interaction from allopathic physicians? an empirically derived approach, J Am Osteopath Assoc
11 of 11

  • The paper relies on this without support.

    Few studies have compared DOs and MDs with regard to the processes of medical care that occur during physician encounters.

    “Thus far, few studies have compared DOs and allopathic physicians (ie, MDs) with regard to the processes of medical care that occur during physician encounters.”

  • The authors state this as an assumption.

    Most spinal manipulation used for patients treated by DOs was osteopathic manipulative treatment, whereas spinal manipulation used for patients treated by MDs was more likely provided by chiropractors or physical therapists.

    “We presume that most spinal manipulation used for patients treated by DOs was osteopathic manipulative treatment, whereas spinal manipulation used for patients treated by MDs may more likely have been provided by chiropractors or physical therapists.”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

  • Percentage of patients treated by DOs is incorrect

    Minor

    The stated 87 patients out of 313 is 27.8%, not 31.9%.

    Reported 31.9 · recomputed 27.795527

1 of 1

Cites

Flagged first, then by citations

2 of the 28 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. Seffinger, 2019, Philosophy of Osteopathic Medicine, 2
  2. Sullivan, 2009, The Pain Catastrophizing Scale: User Manual.

Cited by

Sorted by citations

Related

Authors
Licciardone, J. C., Schmitt, M. E., & Aryal, S.
Affiliations
  • University of North Texas Health Science Center (US)
  • The University of Texas System (US)
Corresponding author
Licciardone, John C.
ORCID
Venue
Journal of Osteopathic Medicine
Publisher
Walter de Gruyter GmbH
Published
2019-07-15
Volume
119
Issue
8
Pages
499-510
ISSN
2702-3648 (ISSN-L)
DOI
10.7556/jaoa.2019.092
OpenAlex
W2961038585
Cited by
16
References
28
Citations by year
2026: 3 · 2025: 1 · 2024: 1 · 2023: 2 · 2022: 2 · 2021: 3 · 2020: 4
FWCI
1.58
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Osteopathic Medicine (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Funders
  • American Osteopathic Association
  • Osteopathic Heritage Foundation
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Empathy and Medical Education
  • Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Keywords
osteopathic physicians, allopathic physicians, physician empathy, physician-patient communication, chronic low back pain, pain catastrophizing, pain self-efficacy, quality of life, opioid use, NSAID use, patient satisfaction, physician-patient relationship, patient-reported outcomes, pain intensity, sleep disorders, depression, anxiety
MeSH terms
Adult, Aged, Communication, Cross-Sectional Studies, Disability Evaluation, Empathy, Female, Humans, Male, Middle Aged, Osteopathic Medicine, Physician-Patient Relations, Low Back Pain, Osteopathic Physicians, Young Adult

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