Think Sick, Get Sick?

A very interesting report was published recently about the power of the mind-body connection (something I’m a big believer in). You’ve probably heard about the placebo effect: the fact that some patients will feel better on a medication, even if there’s no active ingredient–a phenomenon that provides strong evidence for the mind-body connection. But the dark side of the placebo effect is called the “Nocebo Effect”. Meaning, if you believe something is going to make you ill, or give you a negative side effect, it’s more likely to.

In this report, which analyzed the whole body of research on the nocebo effect, researchers found that when people were advised by health care practitioners, typically doctors and nurses, about side effects or harm, they were more likely to report experiencing those symptoms in follow-up visits. It’s not that patients were making it up–they were truly experiencing them.

“Patients are highly receptive to negative suggestion, particularly in situations perceived as existentially threatening, such as impending surgery, acute severe illness, or an accident.” the researchers wrote. “Persons in extreme situations are often in a natural trance state and thus highly suggestible.”

So all of our diligence with informing patients about potential side effects could actually be causing harm?

This also makes me think of pharmacist’s instructions–I’ve had many patients come back to me admitting they’d been too terrified to even start the medication I’d prescribed, after their little chat with the pharmacist.

And, am I the only one who finds those pharmaceutical commercials hilarious? You know, the ones where fully half the air time is spent issuing increasingly dire warnings at auctioneer-speed…(this drug may cause hair-loss or heartburn or night sweats…do not take if breastfeeding, pregnant, on blood thinners, if it’s a full-moon…)

How many of you have had surgery, or even a minor procedure, and after being given a horror-story list of possible dread outcomes, you are then required to sign a paper to say you’re OK with all of that? It’s called “informed consent” and it’s something we’re required to do, legally and ethically, but there’s little doubt it can cause major anxiety for some patients. And stress…well, stress can absolutely cause physiologic change and illness in people.

Some people want to know about every possible outcome. Some people would rather not know. What do you think: is ignorance bliss? If it’s true, like this research is showing, that we are actually inciting symptoms merely by the power of suggestion, are we causing more harm than good, for the sake of full-disclosure? But…how could we possibly justify withholding this information, thus plunging back to the days of patronizing medicine, where “doctor knows best”?

Thorny topic, no?

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One Comment on “Think Sick, Get Sick?

  1. Hi Dr Kim…

    It’s been a while since I have posted; hope your summer is going well. 😉

    As you know, I am a cancer survivor. In addition to taking three different chemotherapy drugs I had major surgery (12 hours in the OR) and numerous diabolically unpleasant procedures over the course of my treatment. My doctors were absolutely and totally clear about ALL the risks – the possible side effect of the chemo drugs, the potential issues with surgery, the risks associated with the blood transfusion which may be required during surgery, and so on and so on.

    In all honesty, I would not have it any other way. I may have felt differently if I didn’t have complete confidence in my medical team. Since I did, the list of possible worst case scenarios sounded little more than a “CYA” speech to me. 😉

    Maybe some people would prefer not to know, and that’s fine. This is entirely a personal thing. However, I always like to know exactly what I am up against. And I certainly would not want to undertake any procedure without having a full understanding of all potential outcomes.

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