16ème Congres national de la SFETD –Novembre 2016 – Recueil des résumés
Plénière 1
PL1-1: The new physiology of the doctor-patient relationship (Pour une "physiologie" nouvelle de
la relation médecin-malade)
Fabrizio Benedetti(1)
(1) University of Turin Medical School, Turin, Italie
We are today in a good position to investigate the complex psychobiological factors that are involved
in the doctor-patient relationship by using a physiological and neuroscientific approach [1]. From a
neurobiological perspective, the doctor-patient relationship can be subdivided into at least four
steps. The first is the step of “feeling sick”, which involves those sensory systems that convey
different pieces of information related to peripheral organs and apparatuses. The second step is
what makes a patient “seek relief”, a kind of motivated behavior which is aimed at suppressing
discomfort. This behavioral repertoire is not different from that aimed at suppressing hunger or
thirst, and the brain reward mechanisms are crucial in this regard. The third step is when the patient
“meets the therapist”, a special and unique social interaction in which the therapist represents the
means to suppress discomfort. Physiology and neuroscience are beginning to understand complex
functions both in the patient’s brain, where expectations, beliefs, trust and hope are key elements,
and in the doctor’s brain, in which empathic and compassionate behavior represents an essential
factor. Finally, the fourth step is when the patient “receives the therapy”, the final and perhaps the
most important act of the doctor-patient interaction. The mere ritual of the therapeutic act may
generate therapeutic responses through the patient’s expectations and beliefs (placebo responses).
Today, the biochemical, anatomical and physiological link between expectation and therapeutic
effect, i.e. placebo responses, has been partially unraveled [2].
Bibliographie
References
[1] Benedetti, F. (2010). The patient’s brain. Oxford University Press.
[2] Benedetti, F. (2014). Placebo effects. 2nd Edition. Oxford University Press.