Background & Aims
Pain management decisions are influenced by many factors beyond the patient’s pain.There is evidence that clinician’s first impressions of patients can influence later clinical decision making above and beyond the patient’s medical information, which may in turn contribute to well-documented disparities in pain care. Here, we tested whether brain correlates of clinician’s empathy when initially viewing patients predicts subsequent pain management decisions in addition to the patient’s pain behaviors. This information could help provide a target for clinician training interventions aimed at reducing biases in pain management.
Methods
A sample of N=67 (34f) medical trainees participated in 36 virtual pain management appointments while undergoing fMRI. Each interaction consisted of 4 parts: 1) a medical vignette with target patient information, 2) pain behavior videos meant to simulate the clinical exam: 3 x 4-second clips of previous research participants responding to evoked pain, and 3-4) pain and treatment rating. To measure clinician first impression empathy unrelated to the patient’s pain behaviors, we measured clinicians’ brain activity in a set of brain regions associated with empathy from an automated meta-analysis (Neurosynth) as they were viewing the patient’s medical vignette.
Results
As predicted, we found that clinician’s initial empathy-related brain responses to the patient, predicted clinicians’ subsequent assessment of the patient’s pain. This was true even when controlling for the intensity of the patient’s pain facial expressions during the intervening simulated clinical exam. In other words, when evaluating patients at equivalent pain facial expression intensity, clinicians predicted the patients to be in more pain when they had higher brain responses in empathy-related brain regions upon first seeing the patient.
Conclusions
Our findings add to the growing body of evidence that pain management decisions are influenced by clinician’s first impressions and empathy for patients, not just their clinical perceptions.
References
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