Medical Research: What is the background for this study? What are the main findings?
Dr. Greville-Harris: Our research looks at the effects of non-understanding feedback (‘invalidation’) and discusses its implications in the medical consultation in eliciting the nocebo response. We carried out interviews with five patients and four healthcare providers to explore their experiences of receiving non-understanding feedback during their chronic pain consultations. Patients reported feeling dismissed and disbelieved by healthcare providers. As a result of these encounters, patients reported feeling angry or hopeless after invalidating consultations, describing an increased need to justify their condition or to avoid treatment altogether.
Our earlier work too, suggests that receiving non-understanding feedback can have very powerful effects. Participants who received such feedback were more physiologically aroused, reported more negative mood and were less willing to participate in the research again. These effects were much more powerful than the positive effects of receiving understanding feedback. Our research suggests that the power of negative communication is stronger than that of positive communication, and that invalidating feedback may be a nocebo effect that has largely been overlooked.
Medical Research: What should clinicians and patients take away from your report?
Dr. Greville-Harris: Communicating a lack of understanding to the patient (even if this is unintentional) can have negative effects in the healthcare setting. We suggest that doctor-patient interactions that do not communicate acceptance and understanding to the patient, may have the potential to facilitate the nocebo effect. Therefore it is important to concentrate on not invalidating patients, rather than simply focusing on communicating understanding, compassion and empathy.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Greville-Harris: Future research needs to look at the effects of validating and invalidating feedback in more detail, particularly in the context of the medical consultation. We need to carry out more research with a larger sample of patients to explore the non-understanding feedback that they receive in the medical setting, and the impact that this has in terms of treatment seeking behaviour, psychological factors and physical wellbeing.
MedicalResearch.com Interview with, Dr Maddy Greville-Harris, Research Fellow, & University of Southampton (2015). Negative Patient-Doctor Communication More Powerful Than Positive Communication