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Nocebo effect: What doctors should not say – more precisely



The placebo effect may heal, which may harm the nocebo effect. Therefore, a doctor should first think carefully about how and what he says to his patients

A situation in the Oncology Day Clinic. A nurse attaches an infusion to the cancer patient who has chemotherapy for the first time: "She is now against the nausea." – "Nausea?", Thinks the patient. The doctor had said in an educational conversation, however, that nausea is now hardly an issue. The infusion drips into her vein, and suddenly it is there, the queasy feeling in the stomach.

While the positive placebo effect can trigger attitudes and expectations, releasing self-healing powers, the nocebo effect does exactly the opposite. If placebo sugar pills can cause an improvement, Nocebos can cause a significant deterioration solely by the patient's anxiety and expectation. The literal translation of the term is finally: "I'll hurt."

Feared to death has also died

The journalist and nonfiction author Werner Bartens has dealt with the phenomenon in his book "That does not look good We would never hear from doctors again "explained. In it, he describes a case in which a primary doctor is standing in front of the bed of an elderly patient with heart problems, together with a group of assistant doctors. With a quick sideways glance at the woman, he notes that this is probably a typical case of "TS."

TS is the abbreviation for a tricuspid valve stenosis, a mostly non-threatening type of valvular constriction. After the visit, one of the young doctors stays with the patient in the room. She says to him, "This is the end now." She firmly believes that TS can only be called a "terminal situation". Despite the attempt to clarify this misinterpretation immediately, her condition worsens. She gets acute shortness of breath, water accumulates in her lungs, and the patient dies of pulmonary edema just a few days later.

The power of thoughtless words

England has so far been the only European country where GPs have their own test Patient interview. Actors practice how to deliver bad news, explain diagnoses unequivocally, and break down medicine into a generally understandable language. Since 201

2, the subject of "communication and discussion" in Germany is officially the subject of medical training. However, the skills of young physicians in communication techniques are rarely tested.

Doctors can not only use their words to heal, but also cause harm – through misunderstood and misunderstood diagnoses, or because the physician points to possible eventualities for his legal protection. Sometimes even just a careless joke leads to misunderstandings. All this can in the worst case cause heart attacks, let tumors grow or cause suicidal thoughts.

In the "Deutsches Ärzteblatt" physicians have collected sayings that are often said in salpless medical jargon, but often fatal consequences. "Maybe this medicine helps", "We were looking for metastases – the finding was negative", "You are a high-risk patient", "It always hurts like hell", "You should not lift anything more heavy – not that you are still paralyzed "," You do not need to be afraid now "or" That's bleeding a bit now ": With such and similar sentences, nurses and doctors want to scare their patients – and even more frighten them.

Fear of side effects [19659005] The Salzburg internist and cardiologist Jochen Schuler knows everyday hospital life with all his verbal misunderstandings and pitfalls. In the meantime, he has switched to an interdisciplinary elective medical ordination. He no longer wants to have "in-between" conversations with his patients, wants sick people to listen to their (fatal) fears with listening and patience and find the appropriate therapies for them.

Trust is the basis of every good one doctor-patient relationship. "It's only when I've arrived on such a basis of trust that I can understand why the patient gets beta-blockers prescribed for heart problems, but does not take them because he's afraid of the erectile dysfunction that might occur," says Schuler. An appropriate response would be something like the sentence: "Try to ignore the reported side effects now, and if the remedy really does not suit you, we'll switch to another."

Transparency is a second important issue. When the cardiologist examines a heart, he always praises it first: "I say that it works well, beats vigorously, and that it is basically a healthy heart, and then I always say aloud what I'm seeing right now, I do not let the patient Room to imagine life-threatening situations, he can just follow me on his journey through his body, and almost always I can fend him the fears that it is something very bad. "

Those who believe in the worst happen to do so

Bad thoughts can cause not only a negative mental but also a bad physical condition. Women who are very afraid of having a heart attack die significantly more often than women who do not care about it.

Even patients diagnosed with end stage cancer often believe that they only have a few months left have to live that they actually die soon after. The autopsy often shows astonishing facts in the autopsy: tumors that are still relatively small, that have not yet affected other organs, and that have not metastasized. The American physician and scientist Clifton Meador has been investigating such cases for many years and says, "Some people do not die from cancer but from the fear of it." (Anja Pia Eichinger, 4.4.2018)


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