Abstract
Medical situations are hot spots in the life of a patient with potentially long lasting effects arising from the use of either negative expressions or encouraging statements, or the lack of empathy or a positive physician-patient relationship. Health care personnel should be aware of and evaluate what patients are exposed to, hear and see. Knowing more about the effects of nocebos and negative suggestions, combined with increased attention to these matters, provides the basis for better recognition of detrimental influences in their own clinical environment and to be able to avoid, stop or neutralize them. After anamnesis patients should not be left with a focus on a negative past, but shifted to positive experiences prior to their illness, or to positive expectations in the future following surgery and rehabilitation. For example, after examining an injured leg the doctor should not turn to the computer for documentation unless he has shifted the patient’s focus on the other, unimpaired leg. “Is that painful too? No? Good! Can you feel that? Yes? Perfect! Can you bend that knee, move these toes? Great! That’s good.” This example draws attention to the fact that negative effects (discussed in the following) substantially are dependent on the focus of the patient and thus can be affected by focus shift and distraction. Patients, their symptoms and their healing are negatively affected by the omission of placebo effects, by nocebo effects and by negative suggestions.
Highlights
Reviewed by: Ioanna Spanou, National and Kapodistrian University of Athens, Greece Gaetano Zaccara, Agenzia Regionale di Sanità della
“Is that painful too? No? Good! Can you feel that? Yes? Perfect! Can you bend that knee, move these toes? Great! That’s good.”. This example draws attention to the fact that negative effects substantially are dependent on the focus of the patient and can be affected by focus shift and distraction. Their symptoms and their healing are negatively affected by the omission of placebo effects, by nocebo effects and by negative suggestions
The assurance of company and care can be amended with positive suggestions like “I will not move from your side until you have come through this well.”
Summary
The analgesic effect of metamizol was significantly lower when the intravenous application was not announced (Benedetti, 2013) (Figure 1). With pain relieving interventions like spinal discectomy, knee or shoulder arthroscopies, and percutaneous procedures like stent implantation sham surgery reaches over 70% of the verum effect (Jonas et al, 2015) This means that the placebo effect significantly contributes to most therapeutic interventions (Evers et al, 2018). In most studies of placebo effects the exact wording is not reported, but wide variation in the effects hint at the impact of the specific terms used and we are only beginning to learn how to improve our therapeutic efficacy that way In this context, announcements with the inappropriate wording can decrease or abolish the therapeutic effect, or even result in the opposite of the desired effect. Use of the wrong wording can interfere with our desired therapeutic goals
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