Doctors may downplay pain of disliked patients

A spoonful of sugar helps the medicine go down, but patients suffering from pain can wind up with something more like cod liver oil if they’re not on good terms with their doctor.

If a clinician doesn’t like a patient, he or she is likely to rate the patient’s pain as less severe, according to a University of Northern British Columbia professor who is studying the impact of the clinician-patient relationship on professionals’ assessment of pain.

Pain sufferers often take issue with their treatment, and that’s why the research is so important, said psychology professor and pain expert Ken Prkachin.

Specific complaints include “nobody believes me, no one is taking me seriously,” he said. “You really get that sense when you talk to patients, maybe people are being downgraded because they’re also disliked.”

Dr. Prkachin said people with invisible pain – such as bad backs, as opposed to broken legs – may not get adequate treatment for the problem if the doctor disregards their feelings.

“A good case can be made … that that is going to demoralize patients and contribute to very testy patient-professional relationships. What we’re trying to do is understand what’s going on there and how to change that.”

The research, presented in an article co-written by Dr. Prkachin and five other researchers from the University of Ghent in Belgium, was published in the latest edition of the international journal Pain.

The team combined a new study, completed in the spring of this year, with other findings to develop the theory that while the average person underestimates pain in someone they dislike, health professionals downplay its severity even further.

To arrive at that hypothesis, the team showed study participants photos of patients connected with positive, neutral and negative personality traits. Next, participants viewed videos of the same patients in moderate, severe and no pain.

The participants consistently rated the pain of patients associated with the negative traits, such as egotism and hostility, lower than that of the patients given likable traits.

“When you associate dislikability with a person, it’s like you change an observer’s perception such that they just don’t pay close attention to (the person’s pain-related) behaviour any more,” Dr. Prkachin explained.

Health professionals, who deal with pain on a daily basis, are likely more desensitized due to overexposure, he added.

Serious study should be undertaken into the long-term consequences of misreading the severity of a patient’s pain, he said. Potential ramifications are that people won’t get the care they require, or they won’t follow the clinician’s treatment prescriptions seriously, and therefore continue to suffer.

“Not getting the adequate or appropriate treatment is, in principle, harmful in itself,” he said.

Remedying the situation could be as simple as urging clinicians to set aside their negative feelings and attempt to boost their empathy, he said.

The Globe and Mail