Following on from his highly acclaimed book Placebo Effects, Benedetti has taken his understanding of the neuroscience underpinning the therapeutic response to turn the microscope on the doctor–patient relationship. I was doubtful when reading the publisher’s critique of how access and appreciation of this knowledge would benefit physicians and psychotherapists. At first glance the book is filled with scary pictures of scans and experimental design, yet I found myself developing a huge respect for the author’s vast knowledge, which he shares with the reader in a very accessible fashion. A limited grasp of neuroanatomy is required to understand the significance of the work.
Benedetti breaks down the underpinning conceptualisation of the doctor–patient interaction to four stages: feeling sick, seeking relief, meeting the therapist and receiving therapy. He then takes time to consider how these stages can be affected by various factors, from the nature of engagement with the therapist to alterations in the capacity of people with various illnesses to access this benefit.
The psychosocial context of clinical contact, with the instillation of hope, trust and the expectation of a positive outcome, is shown to be a powerful mediator of the placebo effect. Benedetti extrapolates this to the importance of practical aspects of clear communication regarding interventions and an explanation of the procedure by the clinician. The General Medical Council is rightly concerned that medical students are to be taught the psychosocial skills necessary for an effective clinician. It would be useful for medical students to understand that there is a strong scientific evidence base to the importance of this endeavour. Equally so, doctors who are observed not to take the therapeutic relationship seriously might have to address this in the same way as any other deficit of practice would have to be tackled – with retraining and assessment.