Really cool study on physician “positivity” from 1987, very thought-provoking about managing #uncertainty:
Abstract below, but I encourage reading the paper - it’s short and open access: bmj.com/content/bmj/29…
(H/T @AdamRodmanMD and @drjohnm)
Some thoughts..
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Abstract below, but I encourage reading the paper - it’s short and open access: bmj.com/content/bmj/29…
(H/T @AdamRodmanMD and @drjohnm)
Some thoughts..
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Interesting that physician “positivity” in the study is a mix of certainty and reassurance, with a touch of... deceit 😬. Hardcore paternalism.
“Negativity” is basically conflated with acknowledgement of uncertainty without much elaboration or statement of hope/optimism.
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“Negativity” is basically conflated with acknowledgement of uncertainty without much elaboration or statement of hope/optimism.
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Dr. Simpkin @greyscalespaces and others have studied & argued that acknowledging—nay tolerating—nay embracing uncertainty is healthy for clinicians.
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Not only is uncertainty distressing—and it’s tolerance stabilizing...
But I am also convinced that when we oversimplify, try to make patterns where there are none, ignore complexity or inconvenient details - we make diagnostic errors and fail to connect with our patients.
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But I am also convinced that when we oversimplify, try to make patterns where there are none, ignore complexity or inconvenient details - we make diagnostic errors and fail to connect with our patients.
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But if uncertainty is distressing for clinicians, it must be for patients too.
I don’t know if there’s newer literature on whether addressing uncertainty with patients could affect their perceptions and outcomes.
But *how* it’s done is bound to be a big determinant.
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I don’t know if there’s newer literature on whether addressing uncertainty with patients could affect their perceptions and outcomes.
But *how* it’s done is bound to be a big determinant.
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Doing it negatively, as seen in the study, could be harmful: the nocebo effect.
But being disingenuous and pretending things are clear when the patient sees they’re not might be even more harmful.
I would assume that most patients see it. Our job is to help them manage it.
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But being disingenuous and pretending things are clear when the patient sees they’re not might be even more harmful.
I would assume that most patients see it. Our job is to help them manage it.
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And I do feel that there’s a way to merge the truth of uncertainty with positivity and reassurance - and still provide the beneficial placebo effect..
...of optimism AND of being cared for by the physician. Which was the other fascinating perspective in the paper.
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...of optimism AND of being cared for by the physician. Which was the other fascinating perspective in the paper.
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That when medical science had less to offer, the reassurance and TLC of the physician WERE a big part of the treatment.
That placebo can be so powerful, especially for some patients. We should use it more, whether we’re also writing a script or not.
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That placebo can be so powerful, especially for some patients. We should use it more, whether we’re also writing a script or not.
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