As a dermatologist, one of the most important things I try to be aware of is my patient’s state of mind. Regardless of their concerns, it is always important to ensure that my patient feels like they are being heard – even if I can’t help them. Doing the opposite is what we call the ‘nocebo’ effect, which I will be discussing today.
Nocebo: it is the phenomenon in which inert substances or mere suggestions of substances actually bring about negative effects in a patient or research participant. For some, being informed of a pill or procedure’s potential side effects is enough to bring on real-life symptoms.
The nocebo response is essentially the opposite of the placebo effect: instead of being led to believe that something like a sugar pill will make them feel better, a patient can feel helpless and experiences worsening of their symptoms if their issues are dismissed by their doctor. I’m sure at one point or another, you have had a doctor who didn’t seem to take your concerns seriously – and the side effect of that can lead to feelings of anger, hopelessness and a need to justify yourself.
I’m addressing this today because I think it is incredibly important for there to be a two-way conversation between the doctor and patient. I know that sometimes physicians don’t have all the answers, and I acknowledge that it is very frustrating on both ends – but I do believe that lending an ear, being empathetic and acknowledging your patient’s pain is necessary, even if we don’t have an answer. The patient is already struggling with something no one can fix easily, hence the added frustration of dealing with a doctor who may unintentionally show a lack of understanding doesn’t make it any easier.
I’d like both patients and doctors to bear in mind that doctors need to be apologetic for a lack of a solution – not defensive. Patients, on the other hand, should try to understand that it can be difficult for us to listen and not always be able to provide a solution. However, doctors need to comprehend that patients are simply searching for feedback, even if that just means expressing empathy.
From my practice to yours, I hope the nocebo effect will become a thing of the past as more doctors and patients begin to understand how to best have a healthy, positive and understanding relationship.
Greville-Harris, Maddy et al. “Bad Is More Powerful than Good: The Nocebo Response in Medical Consultations.” The American Journal of Medicine , Volume 128 , Issue 2 , 126 – 129