Why a doctor saying 'it's normal' can backfire
University of California - San Diego
Doctors may think they're saying “Don't panic." But many patients hear "Don't bother" instead.
A new study from the University of California San Diego Rady School of Management suggests that when physicians try to reassure patients by saying their symptoms are “normal,” patients may actually infer that treatment isn't necessary – and become less inclined to seek it.
Published in Nature Human Behaviour, the findings held across 14 experiments involving 9,371 participants and a wide range of health conditions, from menopause and migraines to dental pain, seasonal allergies and elevated blood glucose levels.
Why ‘normal’ can send the wrong message
The idea for the research grew from first author Seyi Lawal's interest in communication around menopause, where patients sometimes report feeling dismissed after being told disruptive symptoms are simply a normal part of aging. Could it be, she wondered, that doctors and patients were interpreting the same conversations differently?
To find out, the researchers conducted 14 studies involving members of the public and healthcare providers. Participants read realistic medical scenarios in which healthcare providers either described symptoms as "normal" or did not. The researchers then measured the participants' willingness to pursue treatment and compared it with what providers expected patients would do.
"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 Lawal, a doctoral student at the UC San Diego Rady School of Management.
Doctors use "normal," it seems, to mean common and well understood. Patients often interpret it as meaning acceptable – or not worth treating.
Fixing the communication gap, making reassurance work
The findings come amid broader conversations about patients feeling dismissed in healthcare settings, sometimes described as “medical gaslighting.” The study identifies a communication gap that may contribute to those experiences, even when doctors are trying to help.
The good news is that miscommunication isn’t inevitable. The researchers also tested two simple ways to reduce it: pairing normalizing language with an explicit recommendation for treatment, and explaining that "normal" was meant in a statistical, not normative or prescriptive, sense.
Both approaches helped close the communication gap.
"Doctors usually have a noble goal. They mean to ease anxiety, but somehow it backfires," said senior author On Amir, professor of marketing and holder of the Wolfe Family Presidential Endowed Chair in Life Sciences Innovation and Entrepreneurship at the UC San Diego Rady School of Management. "Doctors shouldn’t stop reassuring patients. But they should make their meaning unmistakable.”
Co-author Brianna Chew, a doctoral student at the Rady School, said the same lesson applies to patients. Hearing that symptoms are “normal,” she said, shouldn't be taken to mean they are any less serious.
The key takeaway for patients: If you're unsure what your doctor means when they say a symptom is "normal," don't assume it means treatment isn't recommended and you should just live with it. Ask.
Common symptoms can still deserve attention – and treatment.
Full study: “Reassurance through normalization inadvertently suppresses treatment.”
The study was funded in part by the T. Denny Sanford Institute for Empathy and Compassion.
Journal
Nature Human Behaviour
Method of Research
Experimental study
Subject of Research
People
Article Title
Reassurance through normalization inadvertently suppresses treatment
