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Care 

Chapter:
Care
Author(s):

Alfonso Troisi

DOI:
10.1093/med/9780199393404.003.0009
Page of

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date: 24 June 2021

This chapter focuses on the impact of the doctor–patient relationship on patients’ physiology and well-being. The core of the chapter reports recent data on the physiological changes associated with placebo and nocebo effects and relates these findings to the impact of social relationships on health and disease. On average, the placebo effect’s relative weight in therapeutic improvement is around 40%. The most important component of the placebo effect is the doctor–patient relationship, and this is addressed by looking at the evolution of the behavior that underlies any medical act: care of the sick. Natural selection favored the evolution of behaviors aimed at helping group companions who were wounded or sick, through two different mechanisms: kin selection and reciprocal altruism. For a long period of human evolutionary history, care of the sick followed the path of intimate and affectionate relationships. Delegation to unfamiliar experts trained in medical science came much later. The take-home message of the chapter is that the opposition between humanistic and scientific medicine fades if one looks with an open mind at what we currently know about the biological dynamics that regulate the doctor–patient relationship.

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