It seems that throughout life, even as we grew up, we heard from our friends and family comments like “If you think bad thoughts, then you’ll jinx it” or “If you think the worst, then you’ll make it happen.” It seems that in clinical research, these sayings actually have a name… and that name is “nocebo effect.”
In medicine, when we talk about the “nocebo effect,” what we are referring to is the concept that adverse health or clinical events can be produced or influenced by negative expectations. These effects are a direct result of the psychosocial context or therapeutic environment and its impact on a person’s mind and body.
It can be produced by various factors, including verbal cues and past experiences. So, if someone has had prior unsuccessful or negative therapeutic experiences or was provided information in a negative light, it may mediate an undesirable outcome to the therapy.
This effect is now widely recognized in medicine, and we know that negative presentation of a clinical event or therapy can potentially lead to more negative outcomes. Therefore, consideration of nocebo effects in the context of patient-clinician communication and disclosure in routine practice may be valuable in both minimizing the nocebo component of a given therapy and improving outcomes.
A recent article in the Journal of American Medical Association (JAMA) discusses the impact of the nocebo effect on therapeutic outcomes, and how clinician-to-patient communication should take this into consideration. As a physician, I am always conscientious about making sure that I paint as accurate of a picture as I can for my patients so that they know what to expect — both good and bad. But I am also aware of the fact that what I perceive as providing the most accurate picture possible may also be negatively affecting the patient’s perception of a treatment. So how can we balance being forthcoming about all potential outcomes while still minimizing this “nocebo effect”?
When I talk to patients about lab results or therapies, or when I am answering their questions, I take on the perspective of talking to a family member or a friend… I also will think about how I might want the information caringly delivered to me. Frequently, physicians have busy clinic schedules and need to make sure that they get the information to the patients as succinctly and accurately as possible. But I believe that when physicians take the time to provide the information as though they are giving that information delicately to a loved one, they are better able to prepare patients for the worst — and the best — while still delivering that information with a level of warmth that might ensure more of a positive outcome instead of a negative one.
This concept that what occurs in our mind and perception may affect the ultimate outcome should also be taken into consideration for everyday life and interactions with other people. Have you ever had similar interactions with two different people in relatively similar settings but left one interlude feeling happy and positive, while leaving the other feeling upset and unsettled?