Abstract
Healthcare providers often underestimate patients' pain, sometimes even when aware of their reports. This could be the effect of experience reducing sensitivity to others pain, or distrust toward patients' self-evaluations. Across multiple experiments (375 participants), we tested whether senior medical students differed from younger colleagues and lay controls in the way they assess people's pain and take into consideration their feedback. We found that medical training affected the sensitivity to pain faces, an effect shown by the lower ratings and highlighted by a decrease in neural response of the insula and cingulate cortex. Instead, distrust toward the expressions' authenticity affected the processing of feedbacks, by decreasing activity in the ventral striatum whenever patients' self-reports matched participants' evaluations, and by promoting strong reliance on the opinion of other doctors. Overall, our study underscores the multiple processes which might influence the evaluation of others' pain at the early stages of medical career.
Highlights
Unrelieved pain is a major medical problem worldwide, resulting in human suffering and economic costs
Pain underestimation has been documented in medical students, making this population suitable for our research question. We assumed that these individuals would display stronger positive dispositions toward the category of physicians, relatively to lay individuals. This assumption was validated by a pilot experiment (Pilot 1, see Appendix 1) run on an independent population of 155 participants, organized in four groups: 38 Experienced Medical Students (EMS, from the 5th and 6th year), 32 Intermediate Medical Students (IMS, from the 3rd and 4th year), 56 Young Medical Students (YMS, from the 1st and 2nd year), and 29 lay Controls
Note that in all subplots the feedbacks’ position is displayed across three discrete categories to improve readability, in the experiment it changed across a continuum. ‘***”, ‘**”, ‘*” refer to significance associated with paired t-tests or Spearman’s r rank-correlation coefficient at p
Summary
Unrelieved pain is a major medical problem worldwide, resulting in human suffering and economic costs. A popular theory suggests a major role of medical experience Due to their daily exposure to the severe conditions, often characterized by high levels of suffering, healthcare providers could have progressively changed their frame of reference of what characterizes an extreme pain (Bergh and Sjostrom, 1999). They might be inclined to provide less intense evaluations than those individuals (e.g. the average patient) who do not share the same experience.
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