Chronic pain: negative communication with doctors can make symptoms worse
Doctors who communicate to patients that they do not believe or understand them (albeit without meaning to) can actually make people’s symptoms worse, suggests a small study published in the American Journal of Medicine.
A research team recorded and analysed consultations at a pain management clinic involving five women with chronic widespread pain. In interviews, the women reported feeling dismissed and disbelieved by healthcare providers, encountering providers who did not invest in them or show insight into their condition.
Consultants described receiving conflict and criticism from patients, and encountering patients who held entrenched views or who would not believe their diagnosis.
Patients described feeling hopeless and angry after invalidating consultations, feeling an increased need to justify their condition or to avoid particular doctors or treatment altogether.
“Our work indicates that the effects of patients feeling that their doctor doesn’t believe or understand them can be damaging both emotionally and physiologically,” outlines lead author Maddy Greville-Harris. “This could lead to worsening of illness, known as the ‘nocebo response’. Patients bring certain beliefs and expectations to their health care professional, which are moulded by the culture they live in, and their previous experiences. Their expectations will undoubtedly affect the outcome, but improving communication in consultations could make a big difference to patient care.”
Prof Paul Dieppe from the University of Exeter Medical School comments:
“This study is really about humanity in healthcare. We have found that patients perceive a lack of empathy and understanding, even when the doctor is trying to be comforting. Comments such as ‘there’s no physiological reason that you’re experiencing pain’ seek to reassure, but can be perceived as patronising or disbelieving. We now need to see more research in this area, and for that to feed into training doctors to be more effective communicators for every patient they see.”
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Image credit: photophilde
