Doctors’ Attitude toward A Treatment May Influence Patients’ Reaction to It

By Jane Farrell

When you take medicine, your expectation about how well it will work can affect how much relief you get from your symptoms. This is called the placebo effect.

It can even make a treatment that has no biological effect feel like it works because you think it will. And a health care provider’s style interacting with you can impact how you feel about a treatment. But how can a doctor’s expectation affect their patients’ symptom relief?

In a research project funded by the National Institute of Mental Health (NIMH), investigators led by Drs. Pin-Hao A. Chen, Tor D. Wager, and Luke J. Chang at Dartmouth College carried out three clinical simulation studies. These were designed to evaluate how one person’s belief about a pain remedy affects the other’s feelings of pain relief. The results were published online in Nature Human Behaviour.

According to the NIMH, the studies enrolled a total of 194 students. Participants were randomly assigned to play the role of either doctor or patient. Those playing the doctor were first asked to rate their experience of pain relief after applying two creams on their arm: one called “Thermedol” and the other a control cream. The creams were actually the same. But the “doctors” were led to believe that one cream was effective and the other was not.

Next, the researchers tested the “patients’” experience of pain in response to a heat sensation after the subjects playing the doctors applied the creams. The patients reported feeling less pain and showed lower responses to pain with Thermedol.

The subjects who played doctors were told that one treatment was more effective than the other.

The team analyzed both the doctors’ and patients’ facial expressions using a camera and computer software that modeled painful expressions. How much pain the doctors’ facial expressions displayed affected the patient’s overall pain rating and the patients’ own facial expressions of pain, according to the NIMH. The patients reported that the doctors seemed more empathetic when delivering Thermedol.

Similar results were found when scientists ran slightly modified experiments in two follow-up studies. These findings show how subtle social interactions can impact outcomes. However, what the subtle social cues were conveying to patients is unclear. They may have helped the patients know what to expect, increased their own confidence in the treatment, or simply given them more reassurance.

“When the doctor thought that the treatment was going to work, the patient reported feeling that the doctor was more empathetic. The doctor may have come across as warmer or more attentive. Yet, we don’t know exactly what the doctor was doing differently to convey these beliefs that a treatment works. That’s the next thing that we’re going to explore,” Chang says. “What we do know, though, is that these expectations are not being conveyed verbally but through subtle social cues.”

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