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Health care providers' judgments in chronic pain

the influence of gender and trustworthiness

Schäfer, Gráinne; Prkachin, Kenneth M.; Kaseweter, Kimberley A.; Williams, Amanda C. de C

doi: 10.1097/j.pain.0000000000000536
Research Paper

Estimates of patients' pain, and judgments of their pain expression, are affected by characteristics of the observer and of the patient. In this study, we investigated the impact of high or low trustworthiness, a rapid and automatic decision made about another, and of gender and depression history on judgments made by pain clinicians and by medical students. Judges viewed a video of a patient in pain presented with a brief history and rated his or her pain, and the likelihood that it was being exaggerated, minimized, or hidden. Judges also recommended various medical and treatment options. Contrary to expectations, trustworthiness had no main effect on pain estimates or judgments, but interacted with gender producing pervasive bias. Women, particularly those rated of low trustworthiness, were estimated to have less pain and to be more likely to exaggerate it. Unexpectedly, judgments of exaggeration and pain estimates were independent. Consistent with those judgments, men were more likely to be recommended analgesics, and women to be recommended psychological treatment. Effects of depression history were inconsistent and hard to interpret. Contrary to expectations, clinicians' pain estimates were higher than medical students', and indicated less scepticism. Empathy was unrelated to these judgments. Trustworthiness merits further exploration in healthcare providers' judgments of pain authenticity and how it interacts with other characteristics of patients. Furthermore, systematic disadvantage to women showing pain is of serious concern in healthcare settings.

Social cognitive influences on judging others' pain and pain communication show consistent disadvantage to women, particularly those perceived as untrustworthy.

aResearch Department of Clinical, Educational & Health Psychology, University College London, London, United Kingdom

bNeonatal Unit, Queen Charlotte's and Chelsea Hospital, London, United Kingdom

cDepartment of Psychology, University of Northern British Columbia, Prince George, BC, Canada

dDepartment of Psychology, University of British Columbia, Kelowna, BC, Canada

Corresponding author. Address: Research Department of Clinical, Educational & Health Psychology, University College London, Gower St, London WC1E 6BT, United Kingdom. Tel.: +44 2076791608. E-mail address: (A. C. de C Williams).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Received November 22, 2015

Received in revised form February 10, 2016

Accepted February 11, 2016

© 2016 International Association for the Study of Pain
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