When patients with long‑term back pain reach a hospital‑based spine clinic, many feel taken seriously for the first time. They experience being listened to, receiving thorough explanations, and being involved in decisions about their treatment. At the same time, unclear expectations, especially about who they will meet and what the purpose of the visit is, can lead to frustration, disappointment, and unnecessary conflicts during the consultation.
This appears in a study published in the Journal of Evaluation in Clinical Practice, in which researchers from the Danish Chiropractic Knowledge Hub, the University of Southern Denmark, and the Central Denmark Region analysed communication between patients and healthcare professionals at a hospital‑based spine clinic.
The feeling of finally being taken seriously
The study is based on audio recordings of consultations with 12 patients with low‑back pain, as well as follow‑up interviews. A recurring theme in the patients’ accounts is a sense of relief at finally being met with understanding.
Several patients describe how their pain had previously been dismissed as “natural aging” or something they simply had to live with. At the spine clinic, however, they experience their pain being acknowledged and explained, often based on MRI scans.
- It’s the first time I feel that someone truly takes my back seriously, one of the patients in the study says.
According to the researchers, this recognition is highly important for both patient satisfaction and hope for the future. Patients feel better equipped to manage their situation when they understand their diagnosis and prognosis, even if no quick fix exists.
The researchers note that it is positive that patients finally feel taken seriously but also concerning that they must go through at least eight weeks of treatment in primary care followed by months of waiting before this happens.
Unfortunately, this is not new. Many patients are not offered patient education by their general practitioner, despite solid evidence that such education can support return to work and overall improvement. Therefore, the researchers call for better consultations in primary care to prevent back pain from worsening.
Clear communication and shared decision‑making works
The study highlights several forms of communication that work particularly well in consultations. One highly effective approach is when healthcare professionals begin by outlining the structure of the visit: first discussing symptoms, then conducting a physical examination, then reviewing scans, and finally agreeing on a plan for the next steps.
This clear framework helps patients align their expectations and creates a calmer conversation.
Patients also experience that treatment plans are made in collaboration with them, rather than dictated by the clinician. This increases both understanding and the likelihood that patients will follow recommendations.
‘I thought I was going to talk to a medical doctor’
But even in otherwise well‑functioning consultations, problems arise when patient expectations do not match reality. One of the most striking findings of the study is that many patients expect to be examined by a doctor and become disappointed or uncertain when they instead meet a physiotherapist or chiropractor.
In several consultations, the question is raised directly:
- Am I not speaking to a medical doctor at all today?
According to the researchers, this does not reflect distrust of the professionals’ skills, but rather a widespread belief that doctors hold greater authority and knowledge. The problem is reinforced when clinicians themselves refer to doctors as “the ones you ask if you’re in doubt,” which can unintentionally undermine their own professional position.
Misconceptions about surgery and “quick fixes”
The study also shows that some patients arrive at the spine clinic expecting they have been referred for surgery—often because their general practitioner framed the referral that way. When it turns out that treatment instead involves exercise, pain management, and patience, this may lead to both relief and disappointment.
Other patients hope for a quick cure that will eliminate their pain completely. Although such expectations are often unrealistic, most patients still leave the consultation with greater optimism because they now understand their situation better.
MRI scans are helpful, yet problematic
A central and more critical point concerns the use of MRI scans. Patients greatly appreciate having the images explained and see them as “proof” that their pain is real. But research shows that many MRI findings are age‑related and only weakly linked to pain.
According to the researchers, there is therefore a risk that detailed explanations of scans can increase worry and fear and ultimately reinforce the patient’s experience of pain.
The need for better expectation‑setting
The researchers conclude that much could be improved if patient expectations were addressed earlier in the process—for example through better information from general practitioners and more detailed appointment letters.
When patients know in advance who they will meet and what the purpose of the consultation is, time can be used more effectively, and the conversation can focus on what matters most: creating understanding, reassurance, and realistic hope for living with back pain.
Christina Emborg, Camilla Blach Rossen, Lise Hestbæk. ‘Am I not Talking to any Medical Doctors Today?’—Evaluation of Effective and Ineffective Interactional Practices in Spinal Pain Clinic Consultations. Journal of Evaluation in Clinical Practice 2025.
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