The importance of precision of language has been a concept that has grown increasingly prevalent in my mind as of late. Recognizing that our patients come to us with varying degrees of previous interventional experiences and expectations, and the bearing that this has on their ability to respond to a given intervention and treatment plan, cannot be understated.
I have found it increasingly necessary to spend considerable time ascertaining the details of these previous encounters in order to avoid trapping myself within the vortex of each particular patient’s “nocebo box.” Most of us are familiar with the placebo effect, that positive expectations on the part of a recipient of treatment can have profound ramifications in regards to that treatment’s outcome. However, how often do we think about the potential negative consequences for our patient’s negative expectations and the potential for negligence on our parts which prevents a true comprehension of the collective baggage that our patients bring with them to our clinics?
To this end, I have found it extremely helpful to include the following questions in the initial evaluation process. These include:
1. Have you received treatment for this complaint/condition before?
2. Who was the individual delivering the treatment? What was their training/specialty?
3. What were the particular interventions performed?
4. How did those interventions make you feel?
5. Did certain things seem to work better than others? If so (or not) why?
6. What do you think needs to happen in order for you to achieve your stated goal for our time together?
By taking the time to engage our patients in such a manner, we do more to achieve an authentic rapport and convey a “patient-first” mentality then by speeding through to how we plan to address their problem.
Equally important is our own continued professional development, whereby we are better able to understand the pathoanatomical etiologies which underlie the development of certain pain conditions/syndromes. The better we are able to explain pain to our patients, and how it truly works, the more likely we will be to achieve a positive outcome and break them out of the “nocebo box.”
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