In a study where we played a recorded text with positive suggestions to patients under general anaesthesia, the results were astonishing. They experienced less pain and need for analgesics, less nausea and need for antiemetics, and faster recovery after surgery (the data on pain and analgesics are reported in this issue). [1] Usually there is no reaction to auditory or other stimuli, including surgery, expected or observed in patients under general anaesthesia.
This knowledge and appreciation of intraoperative perception should lead us to more thoughtful behaviour in the operating theatre, for example, what noise levels or potentially unnecessary conversations are we exposing patients to, and to consider a wide use of therapeutic communication as a feasible, non-drug support of medical interventions and an integral part of therapy and care.
How did I come to do this research? The answer is that after decades of working as physician, I realised that most of the beneficial things I was able to do for my patients could be traced to a specific principle of talking with people in need. If our basic psychological needs like relationships and belonging, self-esteem, control and avoiding displeasure are neglected, and then combined with stressors like fear, abandonment, pain and helplessness in various risk populations—refugees, rape or accident victims, combatants, or patients—there are terrible consequences, such as post-traumatic stress disorder.
From this a list of issues can be derived that should and must be addressed when taking care of people in need:
- company
- contact
- comfort
- confidence
- information
- control
- instructions
- respect
- safety
- healing. [2]
The exact circumstances do not matter. It could be looking after or transporting an accident victim, caring for a patient who is awake during surgery under a local or regional anaesthetic, talking to an intensive care patient in coma, or accompanying a dying man. These concepts apply whether I’m presenting a workshop about what a physician can do for himself (“the better the condition of the therapist, the better the therapy”), helping students with exam nerves, talking to a heartbroken friend, or taking care of myself when I feel down.
The text of our study intervention is available in the appendix of the article. Using this example and that principle you can create your text in your own words to be authentic and use it in a specific context or to generally improve your communication with patients. It might also be of use with patients who aren’t under a general anaesthetic.
Interestingly, we found effects on pain and medication without using the words “pain” or “analgesics”. It appears that simply addressing a patient’s basic needs positively affects their postoperative pain and perhaps the development of pain during the surgery, and possibly other physiological processes we did not look at.
Ernil Hansen is professor of Anaesthesiology at the University Hospital of Regensburg, Germany. He teaches communication skills to students, nurses and doctors. His main fields of scientific interest are hypnosis-based therapeutic communication (he is on the scientific board of the German Milton-Erickson-Society of Clinical Hypnosis), the integration of hypnosis into clinical medicine and medical education, placebo/nocebo and suggestion research, a less traumatic informed consent, and awake-craniotomy (brain surgery) without medication.
Competing interests: none declared
References:
- Nowak H, Zech N, Asmussen S, Rahmel T, Tryba M, Oprea G, Grause L, Schork K, Moeller M, Loeser J, Gyarmati K, Mittler C, Saller T, Zagler A, Lutz K, Adamzik M, Hansen E. Reduction in pain and opioids after therapeutic suggestions during general anaesthesia – A randomized, controlled multicenter clinical trial. Brit Med J 2020
- Hansen E, Zech N. Nocebo effects and negative suggestions in daily clinical practice – forms, impact and approaches to avoid them. Front Pharmacol 2019; 10:77. doi: 10.3389/fphar.2019.00077