Author: Lisa O’Mary
Medscape
If your patient keeps circling back to a concern when you’re trying to put them at ease, then you’ve probably failed the reassurance test.
A new analysis reveals three crucial steps for effectively reassuring patients when their concern is not clinically problematic, sometimes known as a “no problem” diagnosis. Missing even one step could leave a patient feeling unsatisfied, frustrated, or dismissed, the research suggests.
“Patients might leave the visit feeling like they haven’t been heard and stressed that they now need to find another doctor,” said study coauthor Anne Elizabeth White, PhD, assistant professor at the University of California San Diego School of Public Health and Human Longevity Science.
The findings add to a burgeoning field examining effective reassurance in medicine. Evidence is building that patient satisfaction isn’t the only thing at stake — reassurance may affect health outcomes, too.
Article Key Points
“We know that when people have less worry, they consult less. We know that when you address fears and concerns, people tend to recover better from back pain episodes,” said Adrian C. Traeger, PhD, associate professor at The University of Sydney School of Public Health, Sydney, Australia, who studies how to reassure patients with low back pain. (Traeger was not involved in the new study.) “In that way, [reassurance] is a health intervention.”
The Three Steps
The researchers analyzed 30 clinical encounters — including general surgery, geriatrics, and internal medicine — and identified reassurance as key to the most positive visits. In the study, successful reassurance was defined as “when topic closure was not passively or actively resisted by patients.”
The three steps can be done in any order:
Establish understanding. Use clarifying questions to pinpoint the patient’s concern. (Eg, “Is this the spot on your leg you want me to look at?”) Then gather information. Inviting a patient’s assessment can help reveal their underlying worry: “What makes you interested in your cholesterol?”
Share the clinical rationale. Don’t just say “it’s fine.” Explain why. (Eg, “This lacks the irregular borders we see in malignant lesions.”) Ruling out possibilities or offering alternative explanations can be effective: “We’re not as flexible underneath our skin as we get older. So this is just some loose tissue.”
Give an explicit stance. Use definitive language (“this is a benign lipoma”) and provide a “what if” plan to lower anxiety.
Example 1: Reflux
The situation: An older male patient with reflux asked his primary care provider about a specialist’s letter recommending a visit to consider a repeat endoscopy.
What the physician did that worked: After reading the letter and asking about past endoscopy and new symptoms, the physician explained that the standard of care for reflux is not to have endoscopy every year.
“I would just ignore this for now,” the physician said, noting the letter was likely an automated office mailing. He offered to put the letter in the patient’s chart “just so we can remind ourselves if there’s any symptoms, we can see if we need to go there again.”
Example 2: Post-Op Fluid
The situation: A patient asked a general surgeon about fluid buildup a week after back surgery, which the patient said they “couldn’t get another surgeon to take a look” at.
What the physician did that worked: After examining the area, the surgeon shared his clinical experience as evidence: “I know in my own experience from doing operations back here that the fluid hangs around.”
Limitations
Traeger said a key limitation of the study is the lack of longitudinal data — following up with patients to see if they sought additional care after the visit.
“Some early studies showed we can see a rebound in worry after initial reassurance,” Traeger said. “A patient leaves the consult feeling better initially but then their symptoms come back, and they’ve been told there is nothing seriously wrong with their health. It can be very confusing for patients.”
To be sure, more research is needed, Trager said. Current research is “only scratching the surface because it’s assumed that we are effective at it. But I’m not sure that’s the case.”
Qualitative data like this can be valuable for clinicians who may not receive much communication training, said study coauthor Caroline Tietbohl, PhD, an assistant professor in the departments of geriatric and family medicine at the University of Colorado Anschutz in Aurora, Colorado. She pointed to the unexpected response from patients when she asked their permission to videotape visits: they said thank you. “The patients said, ‘I love my doctor. I’ve had other care where it didn’t go well, and those [clinicians] really need to learn what’s going on here,’” Tietbohl recalled.