If patients perceive a lack of understanding or acceptance from their doctor, it could create anger and distress - physiological conditions that could worsen illness.

"The effects of patients feeling that their doctor does not believe or understand them can be damaging both emotionally and physiologically. This could lead to worsening of illness known as the 'nocebo response'," explained lead author Maddy Greville-Harris from the University of Southampton in Britain.

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.

For the study, the team 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.

Comments such as "there is no physiological reason that you are 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," said professor Paul Dieppe, senior investigator from the University of Exeter.


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