Anesthesia Management: Nocebo effects and negative suggestion in anesthesia

Published in Der Anaesthesist (Oct 2014)

Authors: Zech N, et al

Anesthetists have an impact on patients and healing processes not only through drugs, interventions and therapy but also significantly by their words and personality. A substantial part of observed side effects is caused by nocebo effects and negative suggestion, i.e. by the doctor and the medical surroundings. Every symptom of an illness, side effect or complication can also be induced by the wrong way of talking about it. Patients perceive medical situations, such as an emergency, anesthesia or intensive care as extreme or even as life-threatening. This can induce a natural trance, an altered state of consciousness characterized by increased suggestibility. Suggestions affect mental functions, such as anxiety and pain as well as physical functions. Strong figurative words, ambiguity, misunderstandings, incidental conversations, medical jargon and risk information are prone to generate negative suggestion. Not the informed consent per se but the way it is presented should be under scrutiny. Knowledge about nocebo effects and negative suggestion can help recognize and avoid these more easily. These negative factors depend on the context, i.e. they are strongly influenced by the individual background history and anxieties of the patient and also by the physician-patient relationship. The best protection against harm from informed consent and negative suggestion is a supportive therapeutic relationship.