Patients With a History of Unexplained Symptoms Are More Likely to Misinterpret a Doctor’s Explanation
It is rational to worry that your stomachache may be an ulcer or that chest pain signals a heart condition. Typically, though, this worry goes away with a doctor’s reassurance that you are in good health. But for people with ]]>somatization syndrome]]> , a doctor’s reassurance fails to reassure and may even heighten their sense of worry. These patients report a variety of discomforts and other complaints, while medical exams and tests can find no cause for such symptoms. Over the course of many years, patients may see several doctors in search of a diagnosis. Many of these symptoms are linked to stress, but nothing more specific or helpful than that.
A group of German researchers tested their theory that there’s a disconnect between what a physician says and what a person with somatization syndrome hears, processes, and remembers. After listening to a doctor’s explanation of a hypothetical patient’s abdominal pain, people with somatization syndrome incorrectly recalled a greater chance that the pain was due to medical causes. People without this syndrome correctly recalled the doctor’s explanation. This study was published online on August 1, 2006 by the Public Library of Science.
About the Study
Researchers from the University of Marburg, Germany recruited 85 volunteers, of which 33 had somatization syndrome, 22 had ]]>depression]]> , and 30 were healthy. Each patient listened to three audiotapes of a person discussing a problem—one medical (abdominal pain), one social (not being invited to a party), and one neutral (car damage).
On each 2½-minute tape, four potential causes of the problem were discussed. For the abdominal pain, a doctor explained there was no medical cause for this symptom. Two causes were definitively ruled out (“You don’t have a stomach ]]>ulcer]]> ; I definitely would have seen it on the ]]>ultrasound]]> ”) and two others were described as highly unlikely, but still possible (“With this finding we don’t believe that you have bowel cancer; this is very unlikely”). After listening to the tapes, the volunteers rated the likelihood of each potential cause of the problems. Researchers compared the responses among the three groups of volunteers.
While the three groups equally and correctly recalled the likelihood of each cause for the social and neutral situations, significant differences arose regarding the medical problem. People with somatization syndrome incorrectly recalled a greater chance that the pain was due to a disease. In fact, the two causes that were definitively ruled out by the doctor, including ulcer, were rated by those in the somatization group as most likely to occur, and even more likely than bowel cancer, which was not completely ruled out. Those in the other two groups correctly recalled the doctor’s explanation.
Volunteers in the somatization group were recruited from a hospital specializing in patients with this condition, and therefore probably represent the most severe cases. These findings cannot be generalized to people with mild to moderate forms of this syndrome.
How Does This Affect You?
In this study, there was a disconnect between what the taped doctor said and what the patients with somatization syndrome recalled. But the cause for this disconnection is unclear. Perhaps patients with somatization syndrome are so accustomed to doctors downplaying their symptoms—symptoms that are very real to them—that they automatically overestimate what the doctor says in an attempt to determine the true likelihood of a physical illness.
While somatization syndrome is fairly rare, poor communication and misunderstandings between patients and physicians, unfortunately, is not. This study looked at one side of this interaction, but did not address the physicians’ communication skills, which may prevent a patient from feeling that their concerns are validated and thoroughly investigated.
When choosing your doctor, be sure it is a person you trust. Your doctor should carefully listen to your concerns, use words that you understand, and answer your questions. You should feel comfortable asserting your needs. If this is not the case, it may be time to find a new doctor you can talk to.
Familydoctor.org, American Academy of Family Physicians
National Institute of Mental Health
Escobar JI. Does simple “reassurance” work in patients with medically unexplained physical symptoms? PLoS Med . 2006;3(8):e313.
Rief W, Heitmuller AM, Reisberg K, et al. Why reassurance fails in patients with unexplained symptoms—an experimental investigation of remembered probabilities. PLoS Med . 2006;3(8):e269.
Last reviewed August 2006 by ]]>Richard Glickman-Simon, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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