Wednesday, 19 August 2009

Can words hurt? Patient–provider interactions during invasive procedures

In an article in the Journal PAIN (2005) 114 303-309 Lang et al had this to say:

Patients are often prepared for procedural discomforts with descriptions of pain or undesirable experiences. This practice is thought to be compassionate and helpful, but there is little data on the effect of such communicative behavior. This study assesses how such descriptions affect patients’ pain and anxiety during medical procedures. The interactions of patients with their healthcare providers during interventional radiological procedures were videotaped during a previously reported 3-arm prospective randomized trial assessing the efficacy of self hypnotic
relaxation. One hundred and fifty-nine videos of the standard care and attention control arms were reviewed. All statements that described painful or undesirable experiences as warning before potentially noxious stimuli or as expression of sympathy afterwards were recorded. Patients’ ratings of pain and anxiety on 0–10 numerical scales (0 No Pain, No Anxiety at All and 10 Worst Pain Possible, Terrified) after the painful event and/or sympathizing statement were the basis for this study. Warning the patient in terms of pain or undesirable experiences resulted in greater pain (P!0.05) and greater anxiety (P!0.001) than not doing so. Sympathizing with the patient in such terms after a painful event did not increase reported pain, but resulted in greater anxiety (P!0.05). Contrary to common belief, warning or sympathizing using language that refers to negative experiences may not make patients feel better. This conclusion has implications for the training in medical communication skills and suggests the need for randomized trials testing different patient–practitioner interactions. q 2004 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

This study provides a perfect example of the way that hypnotic suggestion works.

When will health professionals realise that when they talk, their words are powerful. Pregnant women get this negativity all the time with the talk of 'risk' in relation to their normal, natural process of giving birth. The negative talk creates a self fulfilling prophecy for many women. Then the 'care' givers can use the outcome to reinforce what they think and say, not realising that they created what they believed to be true.

As the above article demonstrates, words are powerful. The sort of words that should be used around birthing women are words that foster a sense of normalcy, increase self efficacy, build self worth and self trust. Every health professional who has anything to do with birthing women should be working to build capacity for wellness and optimal psychophysiological functioning with every woman they interact with.

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