Negative communication between doctor and patient could make symptoms worse

Doctors who unintentionally communicate to patients that they don't believe or understand them could actually make symptoms worse, a new study suggests.

The research by the Universities of Southampton and Exeter indicates that a type of 'nocebo' response, where patients perceive a lack of understanding or acceptance from their doctor, could create anger and distress - physiological conditions that can worsen illness.

"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," says lead author Dr Maddy Greville-Harris, from the University of Southampton. "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. This is a small study and more research is needed on a larger scale."

Published in the American Journal of Medicine, the researchers recorded and analysed consultations at a pain management clinic involving five women with chronic wide-spread pain. During subsequent interviews, patients reported feeling dismissed and disbelieved by healthcare providers, encountering providers who did not invest in them or show insight into their condition.

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.

Consultants described conflict and criticism from patients, encountering patients who held entrenched views or who would not believe their diagnosis.

The team's earlier work has shown that feeling disbelieved can lead to increased anger and stress - and that this is much more powerful than positive reinforcement.

In the research, 90 participants took part in mathematical tests and were randomly assigned to an experimenter who either gave understanding feedback, using phrases such as "lots of people find these tests hard", or non-understanding feedback, with phrases such as "I don't understand why you're struggling - it's just numbers."

Professor Paul Dieppe, an NIHR Senior Investigator from the University of Exeter Medical School, said: "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."