Medical Provider Reactions to an Adolescent Chronic Pain Complaint and a Dismissive Interaction

Abstract

Childhood chronic pain impacts approximately 15-33% of children and adolescents and can significantly impact physical and psychosocial functioning. Children and adolescents with chronic pain have a decreased ability to participant in normal childhood activities and are more likely to have sleep difficulties, anxiety and depressive symptoms, and sedentary behavior. The etiology underlying chronic pain can be particularly difficult to diagnose because often, it does not have a clear physiological etiology and assessment relies almost solely on patient report. This often leads to under-treatment of pain and can lead to pain dismissal, particularly by medical providers. The literature regarding diagnosis and treatment of childhood chronic pain, pain dismissal in adult and adolescent populations, provider perspectives on chronic pain, and provider communication is reviewed. While there are studies examining the perception of pain dismissal in adult and adolescent populations, little is known about medical providers’ understanding and perception of dismissal. This study investigated the reaction of medical providers to two different scenarios: an adolescent pain complaint via a short vignette and a dismissive patient-provider scenario via a short video. Overall, medical provider participants did not endorse dismissive beliefs after reading a common adolescent headache complaint and were able to consistently identify dismissive language in the dismissive patient-provider scenario. Though significantly underpowered for interaction effects, the results suggest that there is a potential provider and patient gender interaction when participants viewed the dismissive scenario, such that mismatched gender dyads led to more polarized responses. Additionally, exploratory analyses suggest medium to large effect sizes when examining the impact of patient gender and type of scenario viewed (dismissive versus non-dismissive). Specifically, female patient gender appears to be polarizing, such that when viewing the dismissive scenario, participants who viewed the scenarios with the female patient rated the provider lower and when viewing the non-dismissive scenario, participants who viewed the scenarios with female patient rated the provider higher. The current study is a first step in understanding medical providers’ view of dismissive behavior, and has important implications for educational efforts to protect adolescent patients from the experience of dismissal. A discussion of future directions and clinical implications are included.