Nocebo Phenomenon in Doctor-patient Communication

Muhammad Saaiq, Khaleeq-Uz-Zaman

DME, SZABMU/ PIMS,ISLAMABAD

Nocebo Phenomenon

It is the induction of a negative symptom by the patient’s own negative expectations and/or by negative suggestions from the clinical staff .

Nocebo effect often results from Mis-communication

Unintentional Negative Suggestions

Patient

Induction of new Symptoms or

Worsening of pre-existing ones

Doctor/ Staff

What are the underlying mechanisms

Psychological mechanisms: Similar to the placebo effects of learning by conditioning and reaction to expectations.

Neurobiological mechanisms: Placebo and nocebo effects are based on similar neurobiological events.

Inter-individual variations: Women were more susceptible to conditioning and men to generated expectations

Unintended negative suggestions in Oureveryday clinical practice

Ineffective negation and trivialization:

“You don’t need to worry.”

“It’s just going to bleed a bit.”

“You won’t have pain”

“You won’t die”

You may feel “sting,” “burn,” “hurt,” “bad,” or“pain” when explaining the Injection or procedure.

“Are you feeling nauseous?” (recovery room)

“Signal if you feel pain.” (recovery room)

Focusing attention/ Distraction ina wrong way:

Emphasizing the Negatives:

“You are a high-risk patient.”

“That always hurts a lot.”

“You must strictly avoid lifting heavy objects—you don’t want to end up paralyzed.”

“Your spinal canal is very narrow—the spinal cord is being compressed.”

Causing uncertainty:

“This medication may help.”

“Let’s try this drug.”

“Try to take your medicines regularly.”

“We’re wiring you up now.” (connection to the monitoring device)

“The machine will cut you into lots of thin slices.” (CT Scan)

“Now we’re hooking you up to the artificial nose.” (attaching an oxygen mask)

Unnecessary explanations:

“We’ll just finish you off.” (preparation for surgery)

“We’re putting you to sleep now, it’ll soon be all over.” (induction of anesthesia)

Ambiguity:

Ineffective negation

Focusing attention wrongly

Unnecessary Jargons

Emphasizing the negatives

Causing uncertainty

Ambiguity

Our Study

Questions

1 Whenever I come across an anxious patient in the operating room or on the operating room table or in the procedure room, I try to

reduce the anxiety of the patient by saying2 When a patient is undergoing an intervention under local anesthesia,

I address the anxiety by usually saying3 In the recovery room of the operating theatre, when the patient is

recovering from anesthesia, I allay the anxiety, pain, nausea, vomiting of the patient by saying

4 At the time of changing wound dressing of my patient, I often console my patient and allay his anxiety of pain by saying

5 Sometimes my patient needs distraction of attention and I often say the following sentences/ words to do that

6 In the process of briefing to patients while taking consent or doing counseling, I explain the risks of procedure by using the following

effective sentences7 Can the choice of my words affect the well being of my patients

during communication8 Do you know NOCEBO phenomenon in clinical practice?

Nocebo words and sentences CategorizationDon’t worry, everything will be fine. Counterproductive negation

Don’t be afraid -There won’t be any problem -

There is no danger, it just a small operation

-

You won’t have pain -There is no risk to life -

The injection will hurt a bit Emphasizing the negativeThere may be just a small bleeding -

Tell me if you have any pain Focusing attention on the negatives

Are you experiencing any nausea or vertigo?

-

Is your heart sinking? -

Conclusion

Nocebo phenomenon existed in the clinical practice of the surgeons and anesthetists during their communication with patients. There is need to create awareness among these professionals about the subtle negative messages conveyed by such communication and alert them that the nocebo effects have negative repercussions on the clinical outcomes of their patients. The professionals should be formally educated to avoid nocebowords and phrases.

Thank You

Department of Medical Education,PIMS, Islamabad.

Department of Medical Education,Department of Medical Education,PIMS, Islamabad.PIMS, Islamabad.