The doctor will ask you now

 

Apparently ignorance really can be blissful when it comes to your own medical treatment. Doctors are now being encouraged to ask patients “Do you really want to know?”

The new concept driving doctors to heed caution about cautioning is ‘iatrogenic harm’ — usually a term for the adverse effects of drugs or procedures (otherwise considered medical mistakes or complications) but now also being applied to the adverse effects of information.

However, research has demonstrated an interesting spectacle whereby the more patients are warned about the potential side effects — for example of a new drug — the more likely they are to experience those side effects.

In a study of 76 patients who received beta-blocker treatment for hypertension, erectile dysfunction occurred in 32% of the patients explicitly warned about this side effect compared to only 13% of the patients not specifically informed.

This is alleged to be due to viscerosomatic amplification whereby information influences the experience of symptoms. Not surprisingly, some patients are at greater risk of this than others — and  determining who is tricky.

The ‘nocebo’ phenomenon — the experience of side effects by patients who receive the placebo drug in a clinical trial — is a non-judgemental way to explain how information can exacerbate the experience of nonspecific medication effects.

In light of nocebo and the potential harm from information, doctors are being advised to choose their words carefully.

One option is to ask — do you really want to know all of the possible side effects when knowing them increases your chance of having them?

This is unlikely to bode well in the age of Dr Google — when bliss and ignorance become mutually exclusive.