Does Your Doctor Trust You?

Does Your Doctor Trust You? – Sept 2018 – Source Newsroom: California State University (CSU)

Building a good relationship with your doctor—especially if you suffer from a painful chronic condition—is critical for getting the best treatment possible.

At the same time, clear, open communication with your medical team about how you’re feeling is essential, too.

This is all well and good, but absolutely impossible in the short visits dictated by the profit incentive of medical care these days.  

But results of a new survey by Adam Swenson, Ph.D., professor of philosophy at California State University, Northridge, indicate that doctors can harbor prejudices about how trustworthy a chronic pain patient is based on how he or she communicates.

The research revealed that patients who appeared to be dramatic, depressed or who complained about their pain care were viewed by doctors as not trustworthy.

#dramatic, depressed or who complained about their pain care versus upbeat – asking the impossible

By contrast, those who were stoic or upbeat were seen by doctors as trustworthy.

When doctors feel negatively about a patient—even if they’re not consciously aware of it—those emotions can interfere with a good doctor-patient relationship, and possibly even lead to the wrong treatment.  

If, say, your doctor isn’t sure whether or not you’re being honest about the severity of your pain (or if you’ll really follow through with the treatment she has prescribed), that could damage the care you get.

A Subjective Subject

Swenson hopes his work will help more physicians understand what influences their judgment about patients so they can correct potential distortions; after all, clear communication plays a critical role in identifying the right treatment and that can be hard to do for those with difficult-to-manage conditions.

“The simple verbal exchange between patient and doctor remains the cornerstone of medical diagnosis,” writes Daniel Orfi, M.D.

Swenson’s surveys of more than 700 doctors and patients raises a clear question:

Are patients with chronic pain at a disadvantage because they may be judged by their personality rather than their symptoms?

Though his research did not provide a definitive answer, Swenson says,

“there is other work which suggests the likeability of a patient affects assessments of symptom severity.

And other research finds that pain patients are among the least-liked patients.”

It’s rare to see this admission in print, but it verifies something pain patients have always suspected. Because our condition is so difficult to treat and usually impossible to “fix”, doctors don’t like dealing with us.

We are a problem without a solution – especially when the only effective treatment may be palliative: opioid pain medication.

So what can you do if you’re struggling with hard-to-manage chronic pain and want to create honest, clear communication with your doctor?

Here are some tips from pain management experts:

Use a number scale (with one representing almost no pain and 10 indicating excruciating pain) and words to describe your pain.

For example, use the words sharp, stabbing, or aching, and compare it to other pain you might have experienced, such as a broken arm or childbirth.

This is a useful measure that puts your pain into context, especially if you can compare it to a more common painful experience that even your doctor may have endured.

Describe activities you can no longer do because of your pain, such as sitting through a movie or putting on shoes.

This addresses your functionality, a measure that is more meaningful in the medical context than the level of your pain. Your limitations can be listed, itemized, explained, and they are concrete.

Explain how long you’ve experienced the pain, where you feel it in your body and anything that makes it worse.

Discuss your family history as it relates to your illness as well, and be sure to share how sensitive other family members are or were to pain.

I don’t agree with this last one because pain sensitivity, in general, is not something doctors can relate to or even care about. Pain sensitivity is never a consideration in the medical context.