When patients are unconvinced by reassurance from their doctor that they have nothing to worry about, it may be because their emotional state makes it hard for them to remember all the information the doctor has given them, according to new research in PLoS Medicine.
Many people have worries about their health and seek a doctor's opinion when they have minor symptoms that concern them, for example headaches and stomach aches. If the doctor examines them and says that there is nothing to worry about, most people are reassured. However, some people have a long history of worrying about minor symptoms; they keep going back to the doctor because reassurance has failed. They are said to have "somatization syndrome". It is a common (and so far untreatable) condition that adds to the workload of medical staff and thus increases the cost of health care. Researchers in Germany conducted a study in which patients considered to have this condition were asked to listen to three audiotapes. For comparison, the same tapes were also played to healthy people and to patients with depression.
In one tape, a doctor gave test results to a patient with abdominal pain (a medical situation). The other two tapes dealt with a social situation (the lack of an invitation to a barbecue) and a neutral situation (a car breakdown). Each tape contained ten messages, including four that addressed possible explanations for the problem. Two were unambiguous and negative - for example, "the reason for your complaints is definitely not stomach flu.'' Two were ambiguous but highly unlikely - "we don't think that you have bowel cancer; this is very unlikely.'' The researchers then assessed how well the participants remembered the likelihood that any given explanation was responsible for the patient's symptoms, the missing invitation, or the broken-down car. The patients with somatization syndrome overestimated the likelihood of medical causes for symptoms, particularly (and somewhat surprisingly) when the doctor's assessment had been unambiguous. By contrast, the other participants correctly remembered the doctor's estimates as low. The three study groups were similar in their recall of the likelihood estimates from the social or neutral situation. Finally, when asked to imagine that the medical situation was personally applicable, the patients with unexplained symptoms reacted more emotionally than the other study participants by reporting more concerns with their health.