‘Low-trust’ providers inadvertently increase pain in patients undergoing diagnostic testing
The less patients trust their clinician and provider institution, the more painful is their experience of physically uncomfortable diagnostic procedures.
The effect shows up on functional MRI as increased brain activity in regions involved in pain, emotion and attention—not only during the procedure but also afterward, when patients remember the experience and score its discomfort level.
The findings are from a study conducted at the University of Miami in Florida and published online Aug. 24 in Cerebral Cortex [1].
Senior and corresponding author Elizabeth Reynolds Losin, PhD, and colleagues ran their experiment using virtual physicians whose subtle facial expressions were digitally manipulated to convey varying levels of trustworthiness.
The expressions were developed in a previous project using a sophisticated “data-driven computational modeling approach,” the authors report.
Reynolds Losin and co-authors superimposed the faces on bodies dressed like doctors while applying discomforting levels of heat to the forearms of 42 volunteers serving as patient proxies.
The authors note participants were screened prior to the fMRI session to practice the exercise and make sure they could tolerate the heat stimulus. This was calibrated to approximate pain levels common in outpatient diagnostic procedures such as biopsies, mammograms and MSK injury examinations.
Pain levels experienced in the latter two procedures, it should be noted, might reflect patient perceptions of trustworthiness in radiologic technologists.
Significantly More Pain with Low-Trust Doctors at the Scene
Among the team’s compelling fMRI findings:
- Anticipating the painful procedure from a low-trust compared with a high-trust doctor was associated with increased activity in multiple brain regions, consistent with prior findings of expectations of increased pain and nocebo effects.
- Receiving high stimulus intensity heat from a low- versus high-trust doctor was associated with increased activity in several brain regions previously implicated in somatic pain from thermal stimulations.
- Lower doctor trustworthiness was associated with increased activity within multiple brain systems implicated in nociception and other aspects of pain perception.
- Receiving the painful diagnostic procedure analogue from low- versus high-trust doctors significantly increased Neurologic Pain Signature (NPS) responses during high stimulus intensity heat stimulation.
- The more mistrusting participants felt toward healthcare organizations, the more they demonstrated increased and rippling activity in the supplementary motor area when rating pain intensity from low- versus high-trust doctors.
In addition, Reynolds Losin and co-authors report that participants rated low-trust doctors as significantly less competent, warm and attractive compared with high-trust doctors.
The proxies also found the study rationale “believable” and the virtual medical interactions “moderately realistic.”
Toward ‘Novel Interventions for Improving Patient Care in the Future’
In their discussion, the authors point out that, while they used computationally derived face stimuli to manipulate the perceived trustworthiness of virtual doctors, they don’t recommend the technique for improving real-world relationships between clinicians and patients.
Rather, they write, “our results suggest that even small and implicitly perceived changes in trustworthiness in the doctor–patient interaction may improve patient health.”
More:
The results of the present study, when combined with our prior work in which we manipulated doctor trustworthiness via perceived doctor–patient similarity [2] demonstrates that perceived trustworthiness in doctor–patient interactions may be manipulated via multiple pathways, with effects on both reported pain and its neural correlates, and may point to novel interventions for improving patient care in the future.”
The study is available in full for free.
Dave P. has worked in journalism, marketing and public relations for more than 30 years, frequently concentrating on hospitals, healthcare technology and Catholic communications. He has also specialized in fundraising communications, ghostwriting for CEOs of local, national and global charities, nonprofits and foundations.