There’s nothing quite like the anxiety of visiting your doctor with a worrisome new symptom. And there’s nothing quite like the sublime relief when your doctor examines you and concludes that your symptoms are “normal.”
But even though doctors love to give patients this type of reassurance, it sometimes backfires, according to a new study in Nature Human Behavior. Just because a symptom is normal—hot flashes during menopause, musculoskeletal woes in seniors, migraine headaches in a person with a family history of them—doesn’t mean it needs no treatment, but patients whose doctors comfort them in this way may be less likely to pursue it.
“In the whole course of medical school, there's very little—maybe three hours in four years—that is devoted to patient reassurance,” says On Amir, professor of marketing at the University of California, San Diego’s Rady School of Management and a co-author of the new paper. Yet it’s a skill: how a doctor delivers reassurance—or doesn’t—seems to influence what the patient decides to do next. When the doctor normalizes symptoms, Amir adds, “the patient basically understands from that what they should and shouldn't do, and that’s not the intention at all.”
Says Seyi Lawal, a graduate student at the UCSD’s Rady School of Management and a co-author of the paper: “On the provider side, it seems like the reason that they're normalizing is because they believe it's going to have a positive impact on the patient's mental state, which is understandable. But there's a cautionary signal that people may take this one step further [and conclude that] the doctor doesn't think that it's necessary to do anything to treat it.”
In the study, the researchers assembled a group of more than 9,300 people—some doctors, some other medical caregivers, some from the general population—and ran 14 different experiments on them. In one, 400 people were presented with two scenarios in which a friend visited a doctor complaining of menopause symptoms, including extreme fatigue, weight gain, and joint and muscle pain. In one of the scenarios, the doctor simply recommended medication to treat the symptoms. In the other, the doctor added, “I know this feels overwhelming, but I want to reassure you that these symptoms are normal…You could take daily prescription medication…or you can deal with these symptoms.”
People were then asked to predict whether patients would take the recommended medications. They predicted that patients who hadn’t been reassured would be more likely to take them than those who had been told that the symptoms were normal.
“Every word that doctors use has meaning, it has weight,” says Lawal. “Wanting to reassure patients effectively is an understandable and laudable goal for providers. But I think there needs to be more work done to understand how to best do that without discouraging people from taking action to improve their health.”
Most of the 200 doctors surveyed in the study said they use these types of normalizing statements in their practice, and 84% said they think reassurance encourages patients to continue coming in for treatment. Only 15% believed the statements would decrease the patients’ likelihood of seeking treatment—even though that's what tended to happen in the researchers' simulations.
The study authors found one effective way to frame reassurance, however. When the doctor told patients that their symptoms were normal for people with their condition while also specifically recommending treatment, instead of just mentioning it as an option—a statement like, “You can take daily prescription medication, which I fully support as it will help you feel better, or you can deal with these normal symptoms”—the predicted compliance with treatment increased. That strategy—adding explicit advice to the reassurance—may be the fix that allows doctors both to reassure and persuade patients to stick with a treatment protocol.
“Doctors have this tension,” says Amir. “They want to give the patient choice and agency. When I grew up, that wasn't the case. Doctors just told you what to do, and that's it. Today I think that we may have gone too far. Doctors can be clearer on what they actually recommend.”