Patients who feel that their doctors do not understand or believe them may experience a worsening of symptoms as a result, a new study suggests.

According to UK researchers, patients who perceive their doctors to be lacking in understanding or acceptance may end up feeling distressed and angry, both of which can lead to a worsening of their illness.

"Our work indicates that the effects of patients feeling that their doctor doesn't believe or understand them can be damaging both emotionally and physiologically. This could lead to worsening of illness, known as the 'nocebo response'," explained the study's lead author, Dr Maddy Greville-Harris, of the University of Southampton.

The researchers analysed the consultations patients with chronic pain had with doctors in a pain management clinic. The participants were also interviewed afterwards and during these interviews, many said that they felt they were not believed by doctors. Others said they felt dismissed or that the doctors were not invested in their care.

Some said they felt angry or hopeless after their consultations. This led to them feeling the need to justify their condition or to avoid certain doctors or even their treatment.

Meanwhile, when the doctors were interviewed, they said that some of the patients were very critical, with strong views. Some would not believe the diagnosis they had been given.

"Patients bring certain beliefs and expectations to their healthcare professional, which are moulded by the culture they live in and their previous experiences. Their expectations will undoubtedly affect the outcome, but improving communication in consultations could make a big difference to patient care," Dr Greville-Harris insisted.

She pointed to earlier research she and her colleagues had carried out, which involved people taking part in maths tests during which they were given either positive or negative feedback. Those who were given negative feedback became stressed and angry and this had a bigger effect on them than positive reinforcement.

According to one of the researchers, Prof Paul Dieppe, of the University of Exeter, this latest study is about ‘humanity in healthcare'.

"We have found that patients perceive a lack of empathy and understanding, even when the doctor is trying to be comforting. Comments such as 'there's no physiological reason that you're experiencing pain' seek to reassure, but can be perceived as patronising or disbelieving.

"We now need to see more research in this area, and for that to feed into training doctors to be more effective communicators for every patient they see," he commented.

Details of these findings are published in the American Journal of Medicine.