Doctors less sensitive to pain of disliked patients

Medical professionals are not as unbiased as many people like to think. According to a recent study, people tend to underestimate pain intensity and are less sympathetic to a patient's pain when the patient is not well-liked. The study, published in the October 2011 issue of Pain, has alarming implications for patient care.

For the study, researchers preconditioned 40 participants by showing them pictures of six different patients tagged with simple one-word descriptors about their personalities. The descriptions ranged from negative, such as egotistic or hypocritical, to positive, such as faithful and friendly. Neutral tags, such as conventional and reserved, were also included.

After preconditioning, participants were shown short videos of the patients undergoing a standardized physiotherapy assessment while experiencing shoulder pain. Eight short video fragments, each lasting two seconds, were selected from each patient and shown to the participants.

After each fragment, the participants rated the severity of the patients' pain on a scale of "no pain" to "the worst pain ever felt." The participants were also asked to judge whether the patients were agreeable or disagreeable, sympathetic or unsympathetic, and positive or negative.

Results showed that participants rated the negatively-labeled patients as less likable than the patients associated with neutral traits, and also rated the neutral patients as less likable than the patients given positive labels. Furthermore, high levels of pain in disliked patients were underestimated when compared to assessment of pain levels in liked patients. Finally, observers were less capable of discriminating between different levels of pain expressed by the disliked patients.

Lead investigator Liesbet Goubert, assistant professor of Health Psychology, and co-investigator Geert Combez, head of the Department of Experimental-Clinical and Health Psychology at Ghent University, Belgium, say that the results suggest that the pain of disliked patients PAIN, from B7

who express high pain is taken less seriously by others.

University of Northern British Columbia psychology professor Ken Prkachin, whose research has also been published in the latest issue of Pain, agrees that people tend to underestimate the amount of pain felt by individuals they don't like.

The researchers say that identifying variables that influence pain estimation by others is relevant because pain estimations might influence crucial actions concerning pain management. In a medical setting, this could mean poorer health outcomes and inadequate patient care for disliked patients as healthcare workers become less inclined to help them.

According to Prkachin, people who should be in a position to accurately gauge levels of pain, namely health professionals, are often poor at doing so. As a result, clinicians that underestimate a patient's pain run the risk of performing actions that harm the patient.

This bias makes it more difficult to treat people in chronic pain and those with so-called invisible injuries, says Prkachin. Breaking a leg produces a visible sign, such a cast or crutch. However, if a patient has a bad back, people and even health professionals are often skeptical and thus treat the patient negatively, which can result in more victimization. This is often affected by how likable the patient is in the eyes of healthcare providers.

These results are also relevant in everyday situations as well. People are less willing to help those they dislike and are likely less perceptive of their needs, most likely because they do not empathize with them.