Well Meaning Attempts to Reassure Patients Can Backfire

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SUMMARY: Qualitative study of interpretation of reassurance among patients attending rheumatology clinics: “just a touch of arthritis, doctor?” Researchers report that doctors’ attempts to reassure rheumatology patients that their symptoms are mild or that the disease is in its early stages, can be counterproductive. Patients can be left with the feeling that the doctor has not understood their problems and with raised concerns about possible future pain and disability.

ABSTRACT: Providing reassurance to patients is a key medical task, yet there is little evidence about the best ways to impart it successfully. A qualitative study by Donovan and Blake at the University of Bristol’s Department of Social Medicine shows that doctors’ attempts to reassure rheumatology patients that their symptoms are mild or that the disease is in its early stages, can be counterproductive. Patients can be left with the feeling that the doctor has not understood their problems and with raised concerns about possible future pain and disability.

Writing in this week’s BMJ, a theme issue devoted to the management of chronic disease, the authors acknowledge other studies which have found that patients and doctors often have different perspectives on the same clinical encounter. Whilst efforts have tended to focus on improving the clarity of information provided to patients, Donovan and Blake argue that the key to successful reassurance lies in the doctor’s ability to acknowledge patients’ pain and difficulties.

By means of a qualitative study of tape recordings of consultations and in-depth interviews with 35 patients from two major British cities, the authors found that the doctors’ tendency to emphasise the non-seriousness of the condition contrasted with the patient’s own perception that their lives had already been disrupted and led to heightened fears about pain and disability in the future. The authors conclude that doctors should avoid loaded terms such as “mild” and “early stages” and, at the same time, try to understand and acknowledge patients’ views that their difficulties are serious and require attention.