Doctors Can Impact Symptom Severity

Effective, positive communication between patients and their doctors can prevent worsening symptoms, according to research from the University of Exeter.

When doctors communicate to patients that they don’t believe or understand a patient’s symptoms, they can inadvertently make the symptoms worse, according to research published in the American Journal of Medicine.

Researchers from the University of Exeter Medical School in the United Kingdom TK in order to explore the potential role of negative patient/ doctor communication in facilitating medical responses to consultation. The researchers recorded and analyzed consultations at pain management clinics involving 5 women with chronic wide spread pain.

During the interviews, the patients self reported feeling dismissed by the healthcare professionals, encountering providers who did not invest in them, or show insight into their condition. Consultants subsequently described feeling conflict and criticism from the patients, and encountering patients who held incorrect beliefs or who would not believe their diagnoses. After unsuccessful consultations, patients described feeling angry and invalidated, feeling an increased need to justify their condition, or to avoid certain doctors or treatment overall.

“This study is really about humanity in healthcare,” said senior investigator Paul Dieppe, MD, BSc. “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 patronizing 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.”

Prior research from these investigators discovered that when patients don’t feel believed, it can lead to increased anger and stress — which is much more powerful than positive reinforcement, according to the researchers. During that study, 90 participants took mathematical tests and were assigned to an experimenter who either gave understanding feedback or non understanding feedback. Comments were given such as “lots of people find these tests hard,” for the understanding study facilitators, or “I don’t understand why you’re struggling, it’s just numbers,” from non understanding facilitators.

“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,” said lead author Maddy Greville Harris, MSc, PhD. “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 molded 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. This is a small study, and more research is needed on a larger scale.”

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