By BRIAN GOLDMAN, MD

Whether at work or at home, pleasantries can make life a lot easier.

And based on the results of a study published in the October 2011 issue of the journal Pain, the same may be true in the doctor’s office.

Researchers from Ghent University in Belgium took forty men and women (seventeen men and twenty three women) – none of whom were health professionals – and showed them photos of six different patients labeled two each with negative traits (e.g. egoistical, hypocritical, or arrogant), neutral traits (e.g. reserved, or conventional), or positive traits (e.g. faithful, honest, or friendly). After viewing the photos, participants watched short videos of the same six patients undergoing a standard physiotherapy assessment for shoulder pain. Then they were asked to rate the level of pain the patients were experiencing while undergoing the assessment.

Here’s where it gets interesting.  If two patients in the study had identical levels of shoulder pain, the study participants concluded that the patient with the positive attitude had worse pain than the one with the bad attitude.  In other words, if you had pain and had a nice manner, your pain was taken seriously.  If you had the same amount of pain and you weren’t deemed “likeable,” your pain was more likely to be ignored or underrated.

You may wonder if the results would hold true if the participants were health professionals.  While it’s true that we receive special training, we’re only human. We respond to the same emotional cues as everyone else.

In a study published two years ago in the Archives of Internal Medicine, 27% of family doctors said they had lots of difficult encounters with patients as discussed in this article in the New York Times. Doctors were most commonly annoyed by patients who insisted on being prescribed an unnecessary drug. The second most common reason were patients who were always dissatisfied with their care because they had unrealistic expectations – at least according to the doctor.  That tells me health professionals respond to emotions triggered by patient encounters just like everyone else.

Being disliked by your health professional carries a cost.  Disliked patients are more likely to be neglected.  They’re less likely to get appropriate testing and x-rays and also less likely to get proper follow up appointments regarding their medical conditions.  Doctors are more likely to make medical errors on less likeable patients – especially errors of omission or neglect.

I can think of a case of a man who went to a urologist because of an inflamed prostate. He also had a slightly elevated PSA level which kept going up.  The patient was worried about prostate cancer but kept badgering the urologist so often the doctor tuned him out.  Sure enough: he ended up having prostate cancer.

Patients with severe chronic psychiatric conditions like schizophrenia and personality disorders are more likely than those without those sorts of disorders to have cancer, heart disease and other serious disorders go unnoticed by their doctor because he or she is unable to see past the psychiatric condition.

I’ve seen it and I’ve been affected by it.  I’m not proud of this, but I can think of more than one example in which I’ve missed fractures in part because I found the patient to be somehow annoying – at least to me.  I found them annoying because they weren’t interested in my diagnostic opinion so much as they wanted me to confirm that they had a fracture.  I can think of one case in which I took an x-ray, couldn’t see a fracture and told the patient to put ice on it.  She kept say “so how come I can’t use my arm?” but I wouldn’t listen.  Sure enough, she had a fracture.

Dr. Jerome Groopman, who wrote a wonderful book called How Doctors Think has said that many of the errors doctors make come from the emotional side of things.  He said that doctors make mistakes when they find certain patients annoying.

Look, I don’t want to get into blaming the victim here.  However, it pays to at least be aware of how you come across with health professionals.  Talking about ten other occasions when family members were misdiagnosed by other physicians is probably not a good way to start a working relationship.

It’s not helpful to only point out the things that go wrong.  Try to notice and appreciate the times when your doctor or nurse practitioner goes the extra mile for you. Don’t expect them to be focused on you and you alone at all times.  If your expectations are more in line with reality and you have a tendency to be grateful for small benefits, you’ll be less likely to get disappointed.  When you aren’t disappointed, you become more likeable.

On the other hand, if you’re a doctor and you find a patient annoying, instead of being annoyed, ask yourself why you feel that way.  As well, ask yourself whether your feelings might be affecting the treatment you’re providing.  If your feelings are too strong to resolve with some self-talk, then think about referring the patient to a colleague who can bring a fresh pair of eyes and a little less emotional baggage to the examining room.

Dr. Brian Goldman is a veteran ER physician and host of White Coat, Black Art, a CBC radio show that reveals the culture of medicine and the health care system from a physician’s perspective. He is also author of The Night Shift and blogs at Dr. Brian’s Side of the Gurney.