The power of suggestion: How small words can have a big impact on patients’ experiences

Words such as sting, hurt, itch, and worry can have a negative impact on patient perceptions - including pain, according to research being presented at the annual scientific meeting of the Australian and New Zealand College of Anaesthetists (ANZCA) in Brisbane.

Dr Allan Cyna, an Obstetric and Paediatric Anaesthetist at Adelaide’s Women’s and Children’s Hospital said in many cases doctors and medical specialists should consider avoiding words such as try, pain, vomit and panic with patients unless the patient mentions them first.
‘’We already know that telling patients that a procedure will sting increases the likelihood that they will experience pain, ‘’ Dr Cyna explained.
The power of suggestion meant patients, especially those who were highly anxious and distressed, would often go on to experience more pain if it is emphasised and suggested immediately prior to a potentially painful procedure.
‘’Suggestibility increases when patients are highly anxious or distressed. It is also increased in pregnancy and in children,’’ Dr Cyna said.
But Dr Cyna said unfortunately negative suggestions were still frequently used in clinical practice by staff unaware of their harmful effects. Doctors who are mindful of their language by avoiding negative suggestions and/or who use positive language during their communications with patients find that patient responses can include relaxation and improved comfort.
‘’Telling patients that there are ways they can improve their comfort after surgery  -- not only by the use of medications, but also by appreciating that the operation is completed and that everything is settling down as healing and recovery takes place -- can make the experience after surgery more comfortable.’’
Dr Cyna’s research overview paper Little Words BIG impact is being presented as part of an ANZCA conference stream ‘’Communication in Anaesthesia’’ on Tuesday May 16.
Dr Cyna has helped develop a clinical ‘’therapeutic communication’’ strategy called LAURS (Listening, Acceptance, Utilisation, Reframing and Suggestion). This language structure is aimed at helping anaesthetists build patient rapport and assist their patients’ experience in a therapeutic way. Dr Cyna’s approach emphasises the importance of reflective listening so that patients feel that they have been listened to, and understood.
‘’Some clinicians believe that they are being honest by warning patients before a painful procedure such as inserting a catheter into the vein or an injection of a local anaesthetic, that it will hurt or sting,’’ Dr Cyna said.
‘’However, there are at least two reasons why such statements should be avoided. First, the sensation may not hurt in some patients and second, there is an increasing body of evidence showing that using language with negative emotional content can lead to an increase in the patient’s experience of pain or anxiety.’’
In one example presented by Dr Cyna:  ‘’If a patient asks the anaesthetist ‘Will I have much pain after my operation?’ The anaesthetist should always respond honestly by explaining some people have pain while others are surprised that after surgery their recovery is easier and more comfortable whilst healing occurs.’’
‘’Rather than asking about pain, the anaesthetist might ask ‘Is it bothering you? ‘Are you comfortable?’ Or, ‘is it OK to carry on?’”
Dr Cyna said anaesthetists and other medical specialists should talk to patients about why a procedure is being done rather than trying to predict the patient experience. For example, rather than say “this will sting” when injecting local anaesthetic, the anaesthetist could say “we are numbing the skin with local anaesthetic to allow us to finish the procedure as comfortably and safely as possible for you”.
Such strategies are likely to help doctors to better interact with their patients and would likely significantly benefit patient care at no additional cost.
The Australian and New Zealand College of Anaesthetists (ANZCA) is the professional organisation for about 6400 specialist anaesthetists (Fellows) and 1500 anaesthetists in training (trainees).
One of Australasia's largest specialist medical colleges, ANZCA is responsible for the training, examination and specialist accreditation of anaesthetists and pain medicine specialists and for the standards of clinical practice in Australia and New Zealand. 
For more information or to request interviews please contact ANZCA Media Manager Carolyn Jones on +61 408 259 369 or Follow us on twitter @ANZCA.
Monday May 15, 2017
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