Telling patients their symptoms are 'normal' makes them less likely to seek treatment

Reassurance costs nothing and takes about three seconds, which is part of why it is one of the most-used tools in a primary care visit. New research suggests it can also work against the treatment plan.

A study published Aug. 10 in Nature Human Behaviour found that when a clinician described a patient's symptoms as "normal," participants became less inclined to pursue treatment. The effect held across 14 experiments involving 9,371 participants, who evaluated scenarios covering elevated blood glucose, dental pain, migraine, seasonal allergies and menopausal symptoms.

That puts a phrase most physicians use several times a day under scrutiny at a point when patient trust is already a live issue in practice, and when the language used in the exam room is drawing attention in the malpractice context as well.

Clinicians in the study's samples expected normalizing language to nudge patients toward treatment, or at worst to do nothing. Instead, patients moved the other way, reading a statement about how common a symptom is as a statement about whether it is worth treating.

"Providers expected that normalizing a patient's symptoms would increase their treatment likelihood, or at worst have no impact, but patients actually reacted in the opposite way," said Seyi Lawal, a doctoral student at the University of California San Diego Rady School of Management and the study's first author.

What patients actually hear when a symptom is called 'normal'

The researchers attribute the gap to a reappraisal of treatment norms. Told a symptom is normal, participants inferred that their clinician was signaling treatment was not warranted, a conclusion the authors say clinicians do not intend. The paper tests perceived severity and injunctive norms, meaning beliefs about what a person is supposed to do, as parallel explanations for the effect.

The work grew out of Lawal's interest in menopause care, where patients frequently report being told that disruptive symptoms are simply a normal part of aging. The experiments extend the pattern well past menopause and into complaints that turn up in primary care every week.

Two changes that closed the gap

The usable finding for physicians is in what the researchers tested next. Two adjustments cut the effect. One was to follow the word with a direct recommendation to treat. The other was to define it on the spot, telling the patient that "normal" described how often the symptom occurs rather than whether it warrants care.

"Doctors usually have a noble goal. They mean to ease anxiety, but somehow it backfires," said On Amir, professor of marketing at the Rady School and the study's senior author. "Doctors shouldn't stop reassuring patients. But they should make their meaning unmistakable."

Co-author Brianna Chew, also a doctoral student at the Rady School, said the same caution applies in reverse: patients should not treat "normal" as a verdict on how serious a symptom is.

The limits of the evidence are worth reading before rewriting anything. All 14 experiments were conducted online, with participants reading written clinical scenarios rather than sitting in an exam room, a constraint the authors state directly in the paper.

What the studies measured was stated inclination to seek treatment, not treatment actually sought. Whether the effect survives a real visit, with a physician the patient knows, a physical exam and a scheduled follow-up, has not been tested.

What the research does establish is a mismatch worth auditing in your own language. The visit that ends at "that's normal" and the visit that ends at "that's normal, and it's still worth treating" do not land the same way.

The study was funded in part by the T. Denny Sanford Institute for Empathy and Compassion.