Health care providers' judgments in chronic pain: the influence of gender and trustworthiness

Abstract

Estimates of patients' pain, and judgments of their pain expression, are affected by characteristics of the observer and of the patient. In this study, we investigated the impact of high or low trustworthiness, a rapid and automatic decision made about another, and of gender and depression history on judgments made by pain clinicians and by medical students. Judges viewed a video of a patient in pain presented with a brief history and rated his or her pain, and the likelihood that it was being exaggerated, minimized, or hidden. Judges also recommended various medical and treatment options. Contrary to expectations, trustworthiness had no main effect on pain estimates or judgments, but interacted with gender producing pervasive bias. Women, particularly those rated of low trustworthiness, were estimated to have less pain and to be more likely to exaggerate it. Unexpectedly, judgments of exaggeration and pain estimates were independent. Consistent with those judgments, men were more likely to be recommended analgesics, and women to be recommended psychological treatment. Effects of depression history were inconsistent and hard to interpret. Contrary to expectations, clinicians' pain estimates were higher than medical students', and indicated less scepticism. Empathy was unrelated to these judgments. Trustworthiness merits further exploration in healthcare providers' judgments of pain authenticity and how it interacts with other characteristics of patients. Furthermore, systematic disadvantage to women showing pain is of serious concern in healthcare settings.

Limited Knowledge of Acetaminophen in Patients with Liver Disease

“…Female participants in this study were more likely to know that Vicodin® and Percocet® contained acetaminophen than males, which fits with the general findings that women tend to have higher health literacy than men. This observation is important because, despite increased health literacy, women suffer disproportionately low quality of life with liver cirrhosis compared to men44 and tend to have their pain taken less seriously by health care professionals 45. Regarding preferences for sources of health information, our results are in concordance with previous studies, which have demonstrated lower levels of trust in health care professionals among Hispanic patients compared to non-Hispanic white patients 46.…”

Do dog breeds differ in pain sensitivity? Veterinarians and the public believe they do

“…The root causes of the disparity in pain management may be linked to such issues as access to healthcare [6,7]; however, other research suggests that people's perception of pain sensitivity in others may be affected by biases that may in turn influence pain recognition and management. The best studied are the effects of gender [8][9][10] and race [4,[11][12][13][14][15][16][17] on ratings of pain, with research suggesting that physician assessment of pain level of an individual can be influenced by the race of the patient [4,11,12]. Importantly, this difference exists without explicit racial bias on the part of the physician [13,15].…”

The Influence of Social Threat on Pain, Aggression, and Empathy in Women

“…In this study pain expression was reduced almost completely in a context of exploitation 53 . While possibly adaptive in a threatening situation, suppression of pain expression might also have adverse side effects such as underestimation of pain by others, a bias that is common in both lay observers 13,30 and health-care professionals 17,34 . This is especially relevant in a clinical context as there is mounting evidence that chronic pain patients are frequently confronted with threatening social interactions such as stigmatization 31,49,50 , invalidation 32,33 and perceptions of injustice 37,40,41 .…”