title: Qualitative study of Nocebo Phenomenon (NP) involved in doctor-patient communication.
abstract: BACKGROUND
  Doctor-patient communication has far reaching influences on the overall well-being of the patients. Words are powerful tools in the doctor's armamentarium, having both healing as well as harming effects. Doctors need to be conscious about the choice of their words. This study aimed to determine the frequency and pattern of Nocebo Phenomenon (NP) un-intentionally induced by the communication of surgeons and anesthetists through the course of various interventional procedures such as surgery, anesthesia, and crucial communication encounters with their patients.
  
  
  METHODS
  The study was carried out by the Department of Medical Education (DME), Pakistan Institute of Medical Sciences (PIMS), Shaheed Zulfiqar Ali Bhutto Medical University (SZABMU), Islamabad over six months period. All residents and faculty members serving at our institute in various surgical and anesthesia departments constituted the study population. A questionnaire was employed as the data collection tool.
  
  
  RESULTS
  Significant proportions of the doctor-patient communications under scrutiny entailed NP. It was more frequently observed in association with female gender of the involved professionals, residency status versus faculty position, and shorter professional experience (i.e. <5 years). Although the participants endorsed the fact that the choice of their words influenced the well-being of their patients, none of them were actually aware of the concept of NP.
  
  
  CONCLUSIONS
  NP existed in the clinical practice of the surgeons and anesthetists during their communication with patients. It was more frequently found among females, residents and professionals with less than five years of working experience. There is need to create awareness among these professionals about the subtle negative messages conveyed by such communication and alert them that the nocebo effects have negative repercussions on the clinical outcomes of their patients. The professionals should be formally educated to avoid nocebo words and phrases.
authors.affiliation: Department of Obstetrics & Gynecology, Mother and Child Health Centre, Pakistan Institute of Medical Sciences, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan.
authors.forename: Bushra
authors.initials: B
authors.lastname: Ashraf
authors.affiliation: Department of Plastic Surgery and Burns, Pakistan Institute of Medical Sciences, Islamabad, Pakistan.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Saaiq
authors.affiliation: Departments of Neurosurgery and Medical Education, Pakistan Institute of Medical Sciences, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan.
authors.forename: Khaleeq-Uz-
authors.initials: KU
authors.lastname: Zaman
keywords: Doctor-Patient Communication; Nocebo Effects; Nocebo Phenomenon (NP); Nocebo Response; Nocebo Words; Placebo Phenomenon