Search SAFM

Are You a Nocebo?

Long regarded as a nuisance hurdle in pharmaceutical drug testing, the placebo effect is actually a powerful tool that can be harnessed and amplified. In the same way, a nocebo effect (that is, the expectation of a negative result) can turn uncertainty or fear and into dis-ease. In many ways, the Body follows the Mind. A key implication of this truth: How we communicate with our patients is just as important as what we are communicating. Are we promoting strong Belief in the body’s ability to heal itself? Faith? Empowerment? Or are we promoting fear?

Using fear to motivate a patient to comply with your directions can be an enticing trap. Ouch.  I know; I’ve done it too. But what if that fear leads them to take lots of “healthy” actions that are much less effective simply because their expectation stays in a place of weakness, vulnerability, or waiting for the other shoe to drop? What if that fear actually takes them out of true empowerment and into a belief in their dependence on you for their wellness?

This has actually been studied!  And, I hope, gives you some inspiration to consider carefully how you

  1. prepare *yourself* and your mindset prior to your patient appointments.
  2. prepare *your words and actions* in specifically how you will educate, inspire, and empower them.

Consider this study   Out of 200 patients, in those who were given a specific diagnosis and told they would feel better in a few days, 64% did. In those who were told their diagnosis was uncertain and the physician wasn’t sure what would happen, only 39% felt better four days later.  This is a greater than 50% improvement based on practitioner confidence and clarity.  The authors stated, “The doctor himself is a powerful therapeutic agent; he is the placebo, and his influence is felt to a greater or lesser extent at every consultation.”

Consider a report that those who received a lengthy, warm visit (vs. a short, brusque one) from an anesthesiologist the night before surgery required less than half as much painkiller post-surgery than the latter group.  You’ll find many more fascinating examples here.

Setting negative expectations regarding the likelihood of pain increases the incidence of perceived pain. Setting expectations for likelihood of side effects from drugs increases the experience of those side effects.   Check it out!

Do these results surprise you?

While you are focused on building your technical skills and knowledge, let’s all never lose sight of the overarching power of how we show up as practitioners, how we communicate with our patients, and (most of all) how much we love them and believe confidently in their ability to truly be well.  This may require some “unlearning” from the healthcare culture you’ve experienced to date and that offered your foundational training.

Perhaps Dr. Lissa Rankin’s words can shine a bright line on a growth opportunity for All of us – patients and practitioner alike.

In gratitude for sharing your gifts with so many others –




P.S. If you know that healthcare must be transformed to be sustainable and effective, and you believe strongly that Functional Medicine is key to making that happen, we urge you to learn about our semester program.

If you haven’t done so already, sign up to receive weekly clinical tips like this via email, and you’ll also get automatic access to a free mini clinical course.

Like us on Facebook to get more great clinical tips and to get notifications of my next Facebook Live!

Ask a Question

Practitioner clarification questions are welcome! Please do not post personal case inquiries.