Does Your Doctor Trust You?

Newswise — 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.

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. 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

Of course, accurately describing pain can be tricky. "Reports of pain are always subjective and bound up with lots of individual and cultural factors," says Dr. Swenson, who created an interdisciplinary collaboration in 2013 with researchers at the University of Southern California Pain Center. "You and I might be feeling the same amount of pain, but express it very differently." 

​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., in her latest book, "What Patients Say, What Doctors Hear," published earlier this year.

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."

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